BACKGROUND: Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is useful for stent optimization. Outcomes of the ultrathin Supralimus Tetriflex stent (Sahajanand Medical Technologies Pvt. Ltd., India) using IVUS were evaluated among patients with short (≤ 20 mm) versus long lesions (≥ 20 mm).METHODS: A total of 207 patients underwent PCI, and IVUS was performed post-deployment. The primary outcome was optimal stent deployment, defined as (a) mean surface area (MSA) >5.0 mm²; (b) plaque burden <50%; (c) complete apposition; and (d) no edge dissection. Secondary outcomes were target lesion failure (TLF)—a composite of cardiac death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR)—stent thrombosis, and major adverse cardiovascular events (MACE; a composite of death, MI, stent thrombosis, and repeat revascularization).RESULTS: Suboptimal deployment was significantly more frequent among patients with longer lesions (30.1% vs. 23.3%; p=0.03) due to higher rates of malapposition (17.3% vs. 10.6%) and MSA <5 mm² (9.6% vs. 7.7%). Following post-dilatation, suboptimal deployment was observed in 7.6% and 5.8% of patients, respectively. Residual plaque burden was 4.5% and 5.7%, respectively. The MSA in both groups was 6.3 mm² and 6.5 mm². Minimum and mean stent expansions were 82.1% versus 81.7% and 106.3% versus 109.8%, respectively, with no significant differences. TLF and stent thrombosis were observed in 0.9% versus 0.9% and 2.9% versus 3.8% of patients, respectively, with no significant differences. However, MACE was significantly higher (10.5% vs. 8.7%; p=0.05) among patients with longer lesions.CONCLUSION: Supralimus Tetriflex stent has very good optimal deployment based on angiogram and becomes better with IVUS imaging, making it safe among long lesions(≥ 20mm).

Background: Percutaneous coronary intervention (PCI) in ostial coronary artery lesions has been technically difficult because it should be done with precise stent placement in ostium and absence of side branch compromise. The Szabo technique consists of side branch wiring through most proximal stent strut as well as main branch wiring through stent lumen. The side branch wire or anchor wire prevents stent advancement beyond ostial segment and makes possible the accurate stent implantation in ostium. The purpose of this study is to evaluate the feasibility and success rate of Szabo technique analysing technical, angiographic and IVUS(Intravascular Ultrasonography) findings success rate.Methods: We analysed retrospectively in our cath lab, 13 PCIs in 13 patients with a significant lesion at a coronary artery ostium which was treated percutaneously using Szabo technique. The procedure was defined as technically successful if there was neither stent loss nor second guide wire pull back during stent advancement. A successful procedure from angiographic point of view was defined as a precise stent implantation at ostium without side branch compromise. We defined also successful procedure from IVUS point of view consisting of accurate stent placement in ostium without proximal protrusion and without any stent uncovered area. Results: Of a total of 13 patients with 10 (76.9%) males, 46.2% had diabetes, 69.2% hypertension, 53.8% hypercholesterolemia and 23.1 % were smoker or former smoker. They aged from 37-81 years with a mean age of 63±11 years. In 11 (84.6%) patients 6F and in 2 (15.4%) patients 7F sheathless guiding catheter (Asahi Intecc Co; LTD. Japan) were used. The access was radial in 12 (92.3%) and femoral in 1 (7.7%). The culprit vessel was left anterior descending (LAD) in 9 (69.2%), right coronary artery (RCA) 2 (15.4%), circumflex- obtuse marginal (LCX-OM) 1(7.7%), and posterior descending (PDA) 1(7.7%). In 9 (69.2%) IVUS was performed through culprit vessel and in 2 (15.4%) IVUS was done also in side branch after stent implantation. In 11 (84.6%) the procedure was technically successful. Among technically successful patients all (100%) had angiographic success. IVUS examination of culprit vessel showed accurate stent placement in ostium 7 (77.8%) and slight stent proximal protrusion in 2 patients (22.2%).Conclusions: This study shows that Szabo technique is safe and feasible for PCI in ostial coronary artery lesions with a high angiographic success rate. In a high percentage of cases the accurate position of stent in ostium can be confirmed by IVUS.

Spontaneous coronary artery dissection (SCAD) is non-iatrogenic longitudinal separation of the coronary arterial walls, generating true and false lumens. Although it wasknownas a disease of the young females without cardiovascular risk factors, recent evidences have revealed that SCAD can also be seen in older patients having traditional risk factors for ather-osclerosis. In this report, we present a 50-year-old female patient with theSCADof left anterior descending artery (LAD) leading to anteriormyocardial infarction, ten days previously and persisting angina. She was successfully treated using intravascular ultrasound (IVUS) by stenting dissected segment. She has done well since then, and stent patency was demonstrated with coronary computed angiography (CTA) at the fifth-year follow up.