15. Stent thrombosis & Restenosis.pptx
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Dr. Azim Anwar presented on a 59-year-old male patient with uncontrolled diabetes mellitus and refractory angina who previously underwent PCI to the LAD artery in March 2021. The patient's investigations showed elevated HbA1c and ECG changes. Echocardiography revealed anterior wall hypokinesis with 40% ejection fraction. Coronary angiography demonstrated in-stent restenosis of 60% within the drug-eluting stent in the LAD artery, as well as 95% stenosis in the OM2 artery. Treatment options for in-stent restenosis were discussed, including balloon angioplasty, restenting, cutting balloon, and vascular brachytherapy. Risk
15. Stent thrombosis & Restenosis.pptx
- 1. Presenter: Dr. Azim Anwar Phase-B Resident, Cardiology BSMMU
- 2. Dr. Rasul Amin ASSO. PROFESSOR & UNIT HEAD (RED-2 UNIT) , BSMMU
- 3. Mr. Ibrahim Khalil, 59 Years CCS III DM (Uncontrolled) 3 On Query, PCI to LAD on March, 2021. No Documents on Stent details
- 4. Ongoing Management SAPT Statins PPI Bb Mononitrates S/L Nitrates Ramipril Nicorandil Ranolazone 4
- 5. Investigations Trop I CK MB NORMAL S. Creatinine HBA1C 8.9 5
- 6. ECG : T inv in V1-V4 6
- 7. Echocardiography Anterior, A/S, A/L 40% 7
- 8. CCS III with Refractory Angina with Uncontrolled DM CAG with Intend to Revascularization
- 9. LAD - T4. Stent Insitu in P & M. 9
- 10. ISR Pattern III Proliferative 10
- 11. . 60% ISR. dLAD 80% 11
- 12. 12 OM 2 95%
- 13. 13 dRCA Non Critical
- 14. HOW TO TREAT ? 14
- 15. ISR Treatment Type 1 : Balloon Angio/DEB T 2/3/4: Restenting/CABG (Sirolimus, Paclitaxel)
- 16. Head to Head Trial with Balloon Angio: #Cutting Balloon #Excimer laser angio #Atherectomy #Vascular brachytherapy 16
- 17. What to DO ?n Syntax Scoring ?? 17
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- 19. In two or three columns Yellow Is the color of gold, butter and ripe lemons. In the spectrum of visible light, yellow is found between green and orange. Blue Is the colour of the clear sky and the deep sea. It is located between violet and green on the optical spectrum. Red Is the color of blood, and because of this it has historically been associated with sacrifice, danger and courage. 19
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- 27. A picture is worth a thousand words A complex idea can be conveyed with just a single still image, namely making it possible to absorb large amounts of data quickly. 27
- 28. ISR, Why So Important ? 28 1 5 6 2 Balloon Angioplasty 50% Acute Recoil & Acute Vessel Closure DES <10% Pharmaco logical supression of Neointimal Hyperplasia BMS : 20-40% Neointimal hyperplasia Whats Next ??
- 29. Definition of ISR 29 Typically 6-9 month after, on followup ancgiography 03 Either within the stent, Or, 5 mm Prox or distal to the stent margin. 02 Luminal Narrowing of > 50% 01
- 30. Pathophysiology Early, < 3 months Neointimal Hyperplasia Intermediate, 8-13 months: Neointimal Hyperplasia 30 Late, After Years Very Early, <24 H Acute Elastic Recoil or Plaque Prolapse.
- 31. In Stent Restenosis : RISK FACTORS 31
- 32. Procedural & Device Factors: 32
- 33. Procedural & Device Factors: 33
- 34. Procedural & Device Factors: Stent 34
- 35. Procedural & Device Factors: Stent 35
- 36. Procedural & Device Factors: Stent Gaps 36
- 37. Biological Factors: #Genetic Resistance to Rapamycin. #Altered metabolism of Paclitaxel . #Hypersensitive reaction to nickel, cobalt, platinum, chromium. 37
- 38. Patient Factors: #IDDM #ESRD #Small reference vessel diameter #Long lesion length #Ostial lesions # Calcified Lesions #Bifurcation lesion # CTO 38
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- 40. Credits Special thanks to Asso. Professor Dr. Rasul Amin UNIT HEAD (RED-2 UNIT) , BSMMU. And My Colleagues 40