Direct Stenting in AMI via 5F Diagnostic Catheter

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Direct Stenting in AMI via 5F Diagnostic Catheter

December 7, 2011

Courtesy of Aris Moschovitis, MD, Inselspital, Bern, Switzerland

Case Overview

A 47-year old male patient with AMI was thrombolysed and subsequently referred to the tertiary care facility in Bern, Switzerland. Coronary angiography revealed the culprit lesion displaying ruptured plaque in the large distal, right coronary artery (RCA).

Procedural Progression

After estimating the size of the lesion, a 3.5 x 18 mm Svelte IDS was selected to direct stent the lesion through the already engaged 5F JR4 diagnostic catheter.

The system was easily and successfully advanced through the diagnostic catheter and properly positioned across the lesion using the radiopaque markers for guidance.

Following angiography, the decision was made to post-dilate.  Using the same 3.5 x 18 mm Svelte IDS low-compliant delivery balloon, the lesion was post-dilated to 20 ATM.

Conclusion

This procedure demonstrates the feasibility of using the Svelte IDS through diagnostic catheters for distal vessel stenting in an AMI setting. By performing the therapeutic portion of the procedure entirely through the already-engaged diagnostic catheter, substantial time savings and material cost (no guiding catheter, guide wire, pre and post dilatation balloon) were realized. The ability to post-dilate safely with the low-compliant Svelte IDS delivery balloon eliminated the need for an additional non-compliant post-dilatation balloon. The entire procedure was completed in less than 10 minutes.

Keys to Success with the IDS:

  • Ultra-low profile allows access through diagnostic and small catheters (0.047” ID)
  • Reinforced proximal shaft and ASAHI wire tip technology facilitate deliverability with little catheter back-up support
  • Low-compliant balloon with Balloon Control Bands allows for safe, high-pressure post-dilatation
The success of this case demonstrates the potential for reducing the need for ancillary devices and the ability to post-dilate safely at high pressures through diagnostic catheters with the Svelte IDS.  This case is consistent with what we achieved in the SPEED multi-center diagnostic catheter stenting registry study.

– Aris Moschovitis, MD