1. Call for CASES Motaz AbuSamra Krzysztof Milewski CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department: Pawel Buszman, MD, FESC, FSCAI Motaz AbuSamra Krzysztof Milewski CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department: Pawel Buszman, MD, FESC, FSCAI Stent recoil after LM stenting

2. Description of the problem 56-years old man with unstable angina pectoris reffered to ICCU at Upper Silesian Heart Center beacuse of LM disease and CTO of RCA. Medical History: Inferior Myocardial Infarction (2000). Risk factors: hipertonia arterialis. Concomitant treatment: ASA, isosorbide mononitrate, B- blocker, ACE, statin ECG: Q wave in II, III, aVF and T wave inversion in III, aVF. LVEF assessed by echocardiography: 60%. Enzymes: Troponin: negative CPK-MB: 9 U/L Euroscoure : 2

3. Baseline coronarography Coronary angiography showed severe LM stenosis and RCA occlusion (Syntax score = 3 ) Consultants’ Team (Interventional cardiologist and Cardiac Surgeons) decided to send the patient for ULMCA stenting.

4. PCI procedure Administration of ticlopidine and ASA. Routine anticoagulation during procedure. Guiding catheter: Judkins Left 4.0 7F. Taxus stent (4.5x12mm) implantation to the LM ostium under the pessure of 18 atm (direct stenting). Residual stenosis c.a. 50%- stent recoil phenomenon.

5. PCI procedure Renal stent (NEFRO, Balton) implantation into the previously implanted Taxus stent Size: 5,0x8mm Inflation pressure: 16 atm

6. Residual stenosis: 0%. TIMI flow: 3 No complication. No ECG changes in comparison with baseline. Two days after the procedure patient was discharged in good health with no complication. After PCI

7. Seven months f-up Seven months later the patient was controlled with coronary angiography There was no restenosis in LM. CCS class: I

8. Similarity of ostial LM and renal artery disease I.Similarities in vessel wall structures II.Fibrotic/calcified lesions III.Large vessels (>5mm) IV.Elastic recoil V.40-50% coincident rate VI.The same type of disease? VII.PTA/PCI: large stents with high radial forces/support, delivered under high pressure

9. Summary A 56 year old male with unstable angina was admitted to the hospital for interventional diagnosis and treatment. Coronary angiography showed severe LM stenosis After TAXUS stent implantation the recoil phenomenon was observed. It was succesfuly treatet with renal „NEFRO” stent implantation Patient left hospital on combined antiplatelet therapy with aspirin and ticlopidine ordered for 6 months. After 7 months patient was angiographically controlled and no LM stenosis was observed Application of renal „NEFRO” stent is feasible and efficient for leasions locaeted in LM with high elastic force