CASE 2
A 57-year-old male, with a history of an anterior STEMI requiring stenting of the proximal left anterior descending (LAD) 2 years earlier, was admitted with a repeated anterior STEMI due to very late ST. Pre-dilatation with 2.0 mm balloon at very low pressure (6 atm) and bailout thrombectomy (ASAP LP catheter, Merit Medical) due to large thrombus amount were performed. Additionally, intracoronary eptifibatide and adenosine were administered, but TIMI 3 flow was only established after placement of a 3.0x18 mm DES (Xience Sierra, Abbott Vascular) at nominal pressure in the proximal LAD. No post-dilatation (PD) was performed. Four days later, OCT-guided PCI was performed and confirmed an under-expanded stent, but no residual thrombus. A 3.5 mm ultra-high NC balloon (OPN NC, SIS Medical, Frauenfeld Switzerland) at 35 atm was used to enhance stent expansion and an additional DES was implanted distally to correct a geographical miss. Ultimately, a 3.5 mm semi-compliant (SC) balloon was used to achieve optimal stent apposition, which was confirmed on OCT. The patient was discharged on day 5. His left ventricular function had almost normalized at follow-up 17 months later (LVEF 52%).