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CASE20191030_029
IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Imaging: Intravascular
Complete Endothelization of Low Profile Stent After 3 Months and Stop Dual Antiplatelet Therapy with Patient of High Bleeding Risk and High Syntax Score
Alexey Sozykin1, Vladislav Ertman1, Alexandr Shlykov1, Lityaikin Alexandr1, Aleksey Nikitin1, Natalya Novikova1, Emelianov Pavel2, Evgeniy Averin1, Ekateterina Yurevna Kaminskaya1, Stanislav Sergeevich Korzunov1
Central Clinical Hospital of the Russian Academy of Sciences, Russian Federation1, Scientific Clinical Center 2 Petrovsky National Research Center of Surgery NRCS, Russian Federation2,
[Clinical Information]
- Patient initials or identifier number:
1010/9387/2019
-Relevant clinical history and physical exam:
Female, 77y.o. CAD.  Angina on minimal exertion and rest. A-fib. Hypertension. Diabetes type 2. Dyslipidemia type 2b, GFR 56.11 ml / min / 1.73 m2.HAS-BLED Score: 3 point (higher risk of major bleeding).
-Relevant test results prior to catheterization:
ECHO: Aortic sclerosis. LVH ( septum is 1.3-1.5 cm,  posterior wall is 1.2-1.4 cm). DD, grade 1., EF 60%Medications: ASA 100 mg, clopidogrel 75 mg, rivaroxaban 15 mg, losartan 50 mg, bisoprolol 5 mg, atorvastatin 40 mg
- Relevant catheterization findings:
Angio: RCA dominante. Left main 30% in terminal, LAD proximal 80%, CX proximal 80%. RCA 95% of distal part.SYNTAX SCORE: 23, SYNTAX Score II: 55.6, PCI 4 Year Mortality: 45.5% CABG:SYNTAX Score II: 43.1 CABG 4 YearMortality: 19.1%.
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[Interventional Management]
- Procedural step:
Four options for choice: surgery or PCI, something else, but we have a high risk of major bleeding and moderate Syntax and Syntax II for surgery.We chose PCI,  because patient have high risk of major bleeding and we use low-profile stents with a drug coating, which have faster endothelization and OCT which helps to significantly improve the life expectancy of such patients in comparison with surgery (based on ¡°Clinical useof intracoronary imaging, part 2 2019¡±).iFR: LAD distal - 0,79, LCX distal -0,64PCI: 2 ZDES in the  RCA and 2SDES in the Left Main, LAD, CX  (cullote technik), used kissing and POT, with OCT control post PCI and follow up 3 month. After 3 months we see on the OCT the complete endothelization strat of stent. What makes it possible to cancel  DAPT.
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- Case Summary:
OCT control allows to stop DAPT in a short time at HBR patients.Low profile stent Supraflex preferred by HBR patients for faster endothelization.Intravascular visualization OCT allows for PCI in patients with high Syntax.
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