In this brief case review, Drs. O’Kane and Din explain their use of laser atherectomy to treat atherosclerosis in a highly diseased old stent. Their strategy to debulk this vessel with ELCA and facilitate the optimal deployment of a new stent demonstrates the unique and safe approach to this complex case.
high speed cocaine. I'm a consultant interventional cardiologists here at the bottom of hospital Dorset in the UK. Hi Jon Gordon? I'm a consultant interventional cardiologist at the Reform of hospital is 79 year old lady who presented last week with an acute coronary syndromes In the previous step to the right from the artery, which are both bare metal Dilated up to 4.0 mm back in 28. On friday, I treated the circum flex was a severe stenosis for those seeking guidance and a very good result because they brought her back to treat this occluded vessel based on the fact that the echo shows the ventricle is fully viable and contracting well. So we've gone by radio just to get guidance off the retrograde filling past the inclusion. Um And we've actually managed to wire peters managed to wire quite easily across the seclusion with the workhorse wire and micro catheters support having why the vessel. We then related the lesion 2.0 balloon that restored 23 flows. We could de escalate the case by removing the retrograde kits. We're then able then to do some inter korean regime to understand the mechanism of the intercon imaging we've used as with a. C. T. That's been particularly helpful in identifying that this is neo atherosclerosis with possibly some black rupture and thrombosis. Um The old stent looks well expanded and is uh buried under the new in tomorrow. Um So with that information we can then move on to try and treat. We're setting up to use some laser at the rectory now. Um I'm going to tell me about which laser cafta you've chosen and what we're hoping the laser will achieve for us. Okay, so in this situation we're using laser really to try and debunk some of the material within the stent, Which will hopefully when we put a new sentence will have less recoil. Unless material for this tend to go up against in terms of capital selection here because we're seven French. We can go up to 1.7 mm, which I think is a good choice because we don't really need the high energy output in this situation because of soft material. But we want to try and maximize the Luminal gain or the aluminum material. We can the bulk And if we're 1.7 will probably create aluminum around 1.7-2.0 with a laser castor. Yeah, so it's kind of two components to this capital, I guess there's a back end and front end. So the back end is the that's obviously the bit that doesn't go into the patient which is plugged into the machine that's called a proximal coupler. And then at the front end we have really nice tapered tip. Yeah, Very fine. Hold it still is very short monorail just three cm. And it's a very highly deliverable uh tip. So first run I'm just barely gonna move it Right. So you delivered about 7000 pulses with 1.7 laser cafta. And that's been fairly straightforward. So we've got a really good result post laser a threat to me with 23 flow preserved. Um and we're now using the imaging guidance to choose an appropriate size of stent and length of stent. Um and it looks like we can treat this with one new drug eluting stent. The has shown that uh we've a plated quite a bit of the tissue within the stent. And we're now happy to use again the guidance to deployed drug eluting stent. So we're able to accurately measure the length and the diameter of the stent. We've chosen a 35 38 m Zion stent, which we have deployed and then subsequently post related before 375 More compliant blue, which has given us a very good and geographic result. I'm just waiting for the CT. Excellent. A CT result together with the geographic results. So we're happy that we've treated this lesion patients should have a good and durable outcome. Mm.