Authors

 

Vladimir Ivanović^1,2, Dragana Dabović², Milenko Čanković^1,2, Anastazija Stojšić-Milosavljević ^1,2, Milovan Petrović^1,2, Maja Stefanović^1,2, Aleksandra Ilić^1,2, Snežana Tadić<sup>1,2

1</sup>Univerzitet u Novom Sadu, Medicinski fakultet Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, R. Srbija
²Institut za kardiovaskularne bolesti Vojvodine, Klinika za kardiologiju, Put doktora Goldmana 4, 21204 Sremska Kamenica, R. Srbija

 

UDK: 616.12-005.6-073

The paper was received / Rad primljen: 09.04.2019.

Accepted / Rad prihvaćen: 15.05.2019

 

Autor za korespondenciju:

doc. dr Vladimir Ivanović
Klinika za kardiologiju, Institut za kardiovaskularne bolesti Vojvodine,
Put doktora Goldmana 4
21204 Sremska Kamenica
e-mail: vladimir.ivanovic@mf.uns.ac.rs

 

 

Sažetak

 

Uvod. OCT i IVUS predstavljaju modalitete intravaskularnog imidžinga. OCT-om se mogu dobiti dragoceni podaci o različitim pojavama unutar zida i lumena krvnoga suda. Po jednoj od definicija malapozicija stenta je prisutna kada je aksijalna distanca između spoljašnje površine strata stenta i luminalne površine krvog suda veća od debljine strata stenta. Prikaz slučaja. Muškarac dobi 51 godinu juna 2017. godine primljen je zbog STEMI prednjeg zida. Radi se o kompleksnom koronarnom bolesniku, kome je  u dva navrata rađena  PCI  na LAD. Po prijemu juna meseca 2017. godine urađena je rekoronarografija kojom se nađe okluzija LAD u predelu ranije implantiranog stenta-kasna tromboza stenta. Urađene su višestruke balon dilatacije sa NC balonom. Po uspostavljanju TIMI III protoka kroz LAD uradjena je OCT analiza kojom se nađe  malapozicija u proksimalnom delu stenta preko 300 mikrona. Zaključak. Prilikom tretmana ovakvih bolesnika neophodno je pokušati utvrditi uzrok pojave tromboze, a jedini pravi način je primenom intravaskularnog imidžinga.  U slučajevima kasne i veoma kasne tromboze stenta u analizu treba uzeti i pokrivenost stratova stenta sa endotelom za koje je neophodno vreme.  U jednom od novijih OCT istraživanja čiji je cilj bio determinisanje uzroka veoma kasne tromboze stenta glavni uzrok tromboze  u 29.3% slučajeva bila je malapozicija i nepokrivenost stratova stenta endotelom. U našem slučaju radi se o velikom stepenu malapozicije stenta, što je najverovatnije uzrok pojave akutnog STEMI.
Kao što preporuke o revaskularizaciji miokarda govore, kada je moguće treba koristi intravaskularni imidžing radi definisanja uzroka. Zbog svojih prednosti u rezoluciji slike i preciznosti prednost treba po našem mišljenju dati optičkoj koherentnoj tomografiji.

 

 

Ključne reči:

optička koherentna tomografija, stent, malapozicija, intravaskularni imidžing

 

 

Abstract

 

Introduction. OCT and  IVUS are a modality of intravascular imaging. OCT can provide valuable data on various occurrences within the wall and lumen of the blood vessel.   According to one of the definitions, stent malaposition is present when the axial distance between the outer surface of the strata of the stent and the luminal surface of the blood vessel is greater than the thickness of the strata of the stent.
Case Report. A 51-years-old men in June 2017 was admitted because the STEMI anterior wall. It is a complex coronary patient, two times the PCI was done on the LAD.  Upon receipt in June of 2017, a recoronarography was performed and the occlusion of LAD in the area of previously implanted stent-late stent thrombosis was found. Multiple balloon dilations with NC balloon were made. After establishing TIMI III through LAD, an OCT analysis was performed to find malaposition in the proximal part of the stent over 300 microns. Conclusion. When treating this patients it is necessary to try to determine the cause of thrombosis, and the only correct way is  using intravascular imaging. In the cases of late and very late stent thrombosis in the analysis, the coverage of the stent with endothelium should be taken for which time is needed. In one of the recent OCT studies, whose goal was to determine the cause of a very late stent thrombosis, the main cause of thrombosis in 29.3% of cases was malaposition and non-coverage of stentions with stent endothelium. In our case, there is a high degree of stent malaposition, which is most likely the cause of acute STEMI. As recommendations on myocardial revascularization speak, whenever possible, intravascular imaging should be used to define the cause. Because of its advantages in image resolution and precision, the advantage should in our opinion be given to optical coherent tomography.

 

 

Keywords:

optical coherence tomography, stent, malapposition, intravascular imaging

 

 

References:

 

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PDF Ivanović V. et al. • MD-Medical Data 2019;11(2): 099-102