74 y/o previous PCI of the prox LAD LM at that time IFR -; IVUS with dLM nodule but adequate lumen. 6 months later progressive anginal sxs. Nodule eruptive MLA down from 7.5 to 6.7ish and %stenosis 71 with heavy plaque burden. Utilized #shaveandshock w/ @csi360 and @ShockwaveIVL
with Impella support (flat-lined while using 4.0 shockwave). MLA 6.7 -> 11.7 m2! Closed up the hole with a 14French @TeleflexCardiol manta with excellent results. Home following day!
So as many of you have guessed correctly this is a case of ISR 2/2 to Late acquired stent malapposition (LASM). This diagnosis wouldn't have been possible unless you #Imagefirst. But is that that simple. Let's see...
1. We used a 4.0 mm stent proximally in the initial case and then "flared" the ostium with a 4.5 mm NC
2. Here is the full IVUS run. The stent is appropriately sized to the refence segment. We didn't aggressively post dilated the positively remodeled and clot rich proximal/ostial stent but ended up with a big lumen...