Plugged stent technique in direct stenting

概要

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A 78-year-old man was admitted with unstable angina pectoris. His coronary risk factors included hypertension and dyslipidemia. Coronary angiography revealed 90% stenosis at the segment 6 of the left anterior descending coronary artery. We intended to perform percutaneous coronary intervention for the lesion. We estimated with angiography and intracoronary ultrasound that there was a lot of plaque in the lesion. We tried a direct stent implantation in order to decrease the risk of slow-flow phenomenon. While delivering the stent to the lesion, we were not sure if the stent was in the appropriate position or not, because the tight stricture and the stent itself prevented contrast medium from filling into the lumen. We pushed the stent into the lesion immediately after the injection of contrast medium for the purpose of stuffing the stent into the lesion. By this technique (plugged stent technique), we could deliver the stent in the proper position because the lesion was filled with contrast medium that was not carried away and the positional relationship between the lesion and the stent became clear. We succeeded in the procedure without any complications. This technique is especially effective when a lesion cannot be filled with contrast medium due to a tight gap between a stent and the lesional lumen.