Treatment of a Recurrent ISR lesion of pmRCA using Drug Eluting Stent

- Operator : Seung-Jung Park

Treatment of a Recurrent ISR lesion of pmRCA using Drug Eluting Stent
- Operator: Seung-Jung Park, MD
Case Presentation
A 74 year-old gentleman was admitted for PCI. Nine years ago, he underwent PCI at mLAD (Cypher 3.0x28mm) and pmRCA (Arthos 4.0x18mm and 3.5x38mm). Six months later, he experienced ISR at pmRCA, which was treated by POBA. And then, he was followed up regularly and last thallium scan showed normal perfusion. However, recent thallium scan showed reversible large perfusion defect at RCA territory and TMT showed significantly ST depression at second stage. His coronary risk factors were diabetes, hypertension, hyperlipidemia, and ex-smoker. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed mild to moderate LV systolic dysfunction (EF=46%) with RWMA of RCA territory.
Baseline coronary angiography
1. The left coronary angiogram showed patent previous stent at mLAD and collateral flow from LAD to RCA ( Movie 1, Movie 2).
2. The right coronary angiogram was diffuse in-stent narrowing up to 70% of pmRCA stent ( Movie 3, Movie 4).
An 7 Fr JR 3.5 guiding catheter with side holes was engaged at the right coronary artery ostium through right femoral artery. And then, we inserted a 0.014 inch BMW wire into RCA. Predilatation was performed at pmRCA using a Black Hawk balloon 2.5x20mm (Figure 1). After predilatation, we deployed a Resolute Integrity stent 3.0x38mm at proximal to middle ISR lesion of RCA (Figure 2). Thereafter, post-stenting adjunctive balloon dilatation was done using a Dura Star balloon 3.5x15mm (Figure 3). Final angiogram showed that the procedure was successful ( Movie 5, Movie 6).

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