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

Figure 1

Subsequent PCI was performed with a 3.0 x 16 mm everolimus eluting stent. from distal LM to LAD, according to Murray law

Figure 2

Control angiography showed a satisfactory result

but control OCT revealed severe proximal struts malapposition

Figure 3

A POT (proximal oversizing technique) / side branch dilation/ re-POT sequence was decided with compliant balloons

Figure 4

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Figure 9

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.

Figure 10

Summary :

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.