1. Subacute Occlusion at distal Edge of Stent Beijing Anzhen Hospital Capital Medical University Wu, Xiaofan

2. 63-year-old male Sudden onset of CP 4 days after PCI Cardiovascular risk factors: DM Electrocardiogram: mild ST elevations in V2-5 TnI ↑ : 0.8 ng/ml Clinical Presentation

3. Previous Angiogram and PCI 01/20/01 at other H: AMI (inferior) pLCX95% → S660 2.5*9mm 10/15/09 at Anzhen H: unstable angina mLAD70% → Cypher select 3.0*33mm 10/19/09 at Anzhen H: sudden CP occlusion at distal edge of stent at mLAD

4. Baseline Angiogram Initial angiogram on 10/19/09 Occlusion at distal edge of stent at mLAD

5. Review of previous coronary intervention A 70% stenosis at mid LAD with diffuse calcium, LCX (-), RCA (-) Initial angiogram on 10/15/09

6. Review of previous coronary intervention Coronary stenting on 10/15/09 Pre dilation with a safecut balloon 2.0*15mm A Cypher stent 3.0*30 mm at mid LAD Post dilation with a Quantum 3.0*12mm

7. Review of previous coronary intervention Final angiogram after stenting on 10/15/09 A haziness at distal edge of stent in mLAD

8. Baseline IVUS at 10/19/09

9. A B C C B A

10. Coronary intervention on 10/19/09 Pre dilation with a Ryujin balloon 2.5*15mm, occlusion expanded to distal LAD

11. Coronary intervention on 10/19/09 A Lepu stent 2.5*18 mm and A Lepu stent 2.75*18mm distal to previous Cypher stent, occlusion continued to expand

12. Coronary intervention on 10/19/09 An Endeavor stent 2.25*14mm at distal LAD Final angiogram after stenting

13. Post IVUS at 10/19/09