Marc Sintek

Here is the result when he came back for staged PCI to a vein graft lesion. It may not last but I'm not sure that more stents will fair much better.

There is some neointimal tissue but otherwise it looks pretty good and the fractured segement is probably opposed after angioplasty. Here is the result with no further trx

This is the IVUS after ELCA and Chocolate Balloon angioplasty. Starting at distal edge and coming back and forth through the stent

Another good case of stent fracture. Notice the ISR is right at the hinge point of the stent. Lots of symptoms despite meds (1/3)

@essadii Yep. It's a good example of how slow, careful pullback can tell you the answer. Thanks for checking it out!

@MarcSintek Interesting on that frame it is like you go from full circle of struts to no struts then full circle again, very subtle

Here is the IVUS. Its a long run but at about 25 seconds in watch as the IVUS sits at the site of fracture. In and out, you can see struts in the middle of the lumen. That is classic stent fracture as a cause for ISR. #imagefirst

@UjjwalRastogiMD Not sure there is stent fracture or hematoma there. Aneurysmal segment was the highlight.

@MarcSintek Some stent fracture and some hematoma as well. Aneurysmal segment looks cool. Thanks for sharing.

Post PCI this was a huge vessel but check out the post IVUS. See anything that you don't expect?

Final Angio here. Malapposed stent from the aneurysmal segment. You are not going to appose this one. Most people just stent across it but I suppose you could have used 2 stents and landed at the edge, like we did on the proximal end.

Not proud its been so long since I fired up a post! 68y/o with severe 2 vessel CAD who had been managed medically for 4 years. Presented with heart failure, NSTEMI, EF 30% and then had VT arrest. This is his RCA (1/3)

@DrAmirKaki @PLooserMD @ShariqShamimMD @Atul_SharmaMD @ajaykirtane @SVRaoMD @INC_CathLab @jjlop131 @charitakisc @djc795 @dsutter111 @IzzyO_MD I agree. IVUS is key and it's likely that the circ is fine. Always, always image left main bifurcation. #imagefirst

@PLooserMD @ShariqShamimMD @Atul_SharmaMD @ajaykirtane @SVRaoMD @INC_CathLab @jjlop131 @charitakisc @djc795 @dsutter111 @IzzyO_MD Would IVUS the LCx and that will guide in decision, Goodluck

Still don't believe me...here is the syncvision enhanced image. Amazing how the stent is fractured nearly in half right after the proximal marker on the balloon.

(2/3) Here is the return angio. Notice the flexion of the stent now that her wall motion has improved and the hazy narrowing in stent right in the mid LAD. iFR 0.84 and IVUS to follow.

(1/3)Most amazing stent fracture case on IVUS you will ever see. Lady with Anterior Stemi 3 months ago represented with angina and known severe disease of her RCA and circ. Here is the last pic of her STEMI PCI.

Final result. Diagonal looked great

That prior chromoflow you can see the stent is not apposed well at the proximal edge. Here is the IVUS after we posted

One stent with balloon protection of the diagonal and this is the post IVUS with chromoflow because we were worried about the proximal edge being apposed. What do you think?

Here is the IVUS down the diagonal (we always do both limbs of a bifurcation to understand whats going on). Notice there is basically no disease in the ostium and its huge.

Nice 83 y/o lady with severe AS and this LAD lesion that is IFR positive. Thought for sure diagonal was involved.