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Plaque Shift


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A case presentation of plaque shift

A case presentation of plaque shift

Published in: Health & Medicine, Technology

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  • 1.  
  • 2. CASE PRESENTATION By Dr. Khalid Iqbal Bhatti Post Fellow
  • 3. Sequence
    • Introduction
    • Clinical History
    • Clinical Examination
    • Labs
    • Images
    • Discussion
    • Follow-up
  • 4. Clinical History
    • 52 Years
    • Known case of diabetes mellitus for 14 years
    • Know case of hypertension for 1 year
    • Non smoker
    • Non Asthmatic
    • No previous History of IHD
  • 5. Clinical History contd…
    • Chest pain/heaviness for 3 to 4 hours radiating both arms relieved by nitrates
    • During admission pain recurred
    • Associated with sweating
  • 6. Clinical Examination
    • Pulse 72 beats/min
    • BP 110 / 70 mmHg
    • RR 22 breaths/min
    • CVS Unremarkable
    • ECG ST depression in V2 – V5
  • 7. Labs
    • Troponin less than 0.05 ng/ml
    • Routine investigations Normal
  • 8. Summary
    • 52 yrs present with USA having multiple risk factors and ECG changes
    • Recommended for Coronary cath
  • 9. Images
    • Coronary Angiography
  • 10. Discussion
    • Plaque shift
    • The lateral dislocation of plaque during dilatation therapy, which if directed towards a side branch, may occlude the ostium
    • Snow-plow injury
    • a form of plaque shift that occurs at the carina of the bifurcation where plaque is dislocated from the parent vessel into the ostium of the side branch
  • 11. Predictors  of  side  branch   occlusion
    • Several mechanisms are responsible for SB compromising during bifurcation treatment:
      • Plaque shift “snow plow effect ”
      • Dissection of SB after balloon/stent in MB
      • Spasm of SB
      • SB ostium jailing by stent struts
      • Carina stent-induced displacement
  • 12. Characteristics of bifurcation lesions PCI
  • 13. Identification of Side Branch at risk
  • 14. Identification of Side Branch at risk
    • SB Occlusion during PCI
  • 15. Plaque Shift At Bifurcation Lesions
    • PCI of Bifurcation lesion is challenging
    • Side-branch compromise in 9-67% of cases
    • Protection of side branches is time consuming, associated with more contrast media, radiation, and increased risk of complications as dissection, perforation, CIN
    • In bifurcation lesions in which there is no significant involvement of the side branch, we cannot predict the fate of the side-branch after PCI
  • 16. Plaque Shift At Bifurcation Lesions
    • Intra-coronary near-infrared spectroscopy can identify lipid-core plaques using the Lipiscan (InfraRedx) system
    • Lipid-core plaques are soft, and prone to plaque shift during PCI
    • Side-branch compromise as a result of plaque shift is associated with increased rate of peri-procedural MI and other complications
    • Near-infrared spectroscopy can potentially help to identify bifurcation lesions that are in increased risk of side-branch compromise
  • 17.
    • Both plaque shift from the MB and carina shift contribute to the creation / aggravation of a SB ostial lesion after MB stent implantation.
    • The mechanism of side branch(SB) luminal narrowing after main branch(MB) stent implantation in coronary bifurcation lesions is not completely understood.
  • 18. Management / Protection
    • Accurate stent positioning
    • Protect side-branch with wire
    • Nitrates to exclude spasm
    • Kissing PTCA to side-branch
    • Stent occasionally required
    • IVUS
  • 19. Follow-Up
    • Clinically
      • No symptoms
      • No serial ECG changes
      • Vitally stable
      • Observe for 24 hours
      • Glycoprotein IIb / IIIa inhibitor
  • 20.
  • 21. THANKS