ABSTRACT

A 56-year-old Caucasianmanwas transferred to our department because of non-ST-segment elevation MI. On admission the patient was clinically stable. The ECG showed sinus rhythm, 50 beats per minute, negative T waves in III, aVF. Transthoracic echocardiography revealed hypokinesis of the middle and apical segment of the lateral wall with left ventricular ejection fraction of 60%. The patient was treated with a loading dose of acetylsalicylic acid and unfractionated heparin and was transferred to the cathlab for a coronary angiogram. Coronary angiography performed through the radial access showed aneurysmatic changes of the left circumflex artery with near occlusion of this vessel (90% stenosis by visual assessment) (Fig.1). A loading dose of ticagrelor has been administered and an immediate PCI of the infarct-related artery with guiding catheter Launcher 6FEBU 4.0, and BMW guidewire was performed. Pre-dilatation with balloon-catheter Maverick 3.5 × 15mmup to 8 atm. Due to ectatic dilatation of the arterywe have decided to implant a Self-Apposing® Coronary Stent Xposition S (Stentys SA, Paris, France). Post-dilatationwas performedwith 4.5 × 15mmballoon catheter Maverick XL inflated to 6–8 atm. In optical coherence tomography (OCT) a good stent apposition has been confirmed with a few not adhering struts. The maximal distance between stent struts and the vessel wall was 0.5 mm (Figs. 1 and 2). A complete distal flow in the infarct-related arterywas achieved. After four days of hospitalization the patientwas discharged home in a good general conditionwith a recommendation for the use of dual antiplatelet therapy (acetylsalicylic acid and ticagrelor) for 12 months.