Distal Vessel Stenting in the PDA

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Distal Vessel Stenting in the PDA

October 4, 2011

Jean Fajadet, MD

Case Overview

Diagnostic angiography via radial approach reveals a 90% diameter stenosis in the mid-PDA, severely limiting blood flow to the posterior region of the heart. (A,B) The high degree of stenosis and challenge of navigating into the ostium of the PDA in this right dominant patient were considered in deciding the optimal form of intervention. Direct Stenting the lesion utilizing the advantages of the Svelte ‘All-in-One’ system was determined the best option for success.

Procedural Progression

A 2.5 x 13 mm Svelte Acrobat system was introduced via radial access through a 5F guide catheter.  The 0.012 Wire Tip was shaped and the Svelte system introduced. Once the system exits the distal end of the guide catheter, the integrated torquer was adjusted, tightened and tested facilitating the successful navigation of the RCA and PDA ostium.  Radiopaque markers (C) were advanced into position for stent deployment.  The Svelte stent was deployed with high ATM inflation (D).

The Svelte system was retracted proximally for reassessment of the lesion (E). Final control angiography indicates a highly patent PDA (F) with restoration of normal flow and a satisfying angiographic result.

Conclusion

This procedure demonstrates the capability of the Svelte All-in-One Acrobat system to stent a highly stenosed, small vessel lesion. Navigation of the RCA and access to the PDA ostium was accomplished successfully and with relative ease. The system was advanced into the mid-PDA vessel lesion and deployed without the need for post-dilation. TIMI 3 flow was reflected in the final control angiography.

Keys to Success: 

  • Wire tip and stent flexibility facilitated successful navigation into the ostium of PDA.
  • Low crossing profile allowed for seamless crossing of a tight, distal stenosis.
  • Safe high pressure inflation with BCB protection allowed for maximal lumen gain in a small, distal vessel.