Provisional Stenting with re-POT procedure on distal left main artery.
François DERIMAY, Gérard FINET
Fédération de Cardiologique Médicale
Hopital Cardiologique Louis Pradel, Lyon
A 66 year-old man , with previous history of diabetes mellitus and hypertension was admitted for an unstable angina.
The initial coronary angiography (6Fr catheter) showed a distal LM to proximal LAD tight lesion and no lesion on RCA.
The initial pre-PCI OCT analysis is given
Subsequent PCI was performed with a 3.0 x 16 mm everolimus eluting stent. from distal LM to LAD, according to Murray law
Control angiography showed a satisfactory result
but control OCT revealed severe proximal struts malapposition
A POT (proximal oversizing technique) / side branch dilation/ re-POT sequence was decided with compliant balloons
The final angiography and OCT controls showed an improved result, with final optimal struts apposition.
The patient was admitted 6 months later for atypical chest pain and benefited from a coronary angiography + OCT
These different analyses confirmed the persistent good results of the POT/side/rePOT over time.
The POT/rePOT sequence in provisional T stenting approach for bifurcation lesion treatment allows:
- Optimal stent apposition
- Side branch opening
- No elliptical deformation on the proximal part of the stent
- Respect of the different diameters of the vessels in bifurcation, according to the fractal geometric law.