Case

In-Stent Restenosis of Undersized Stent at LM, LAD and LCX

- Operator : Jung-Min Ahn

In-Stent Restenosis of Undersized Stent at LM, LAD and LCX
- Operator: Jung-Min Ahn, MD
Case Presentation
A 63 year-old male was admitted for recurrent effort chest pain. He had a history of kidney transplantation due to diabetes mellitus nephropathy 2 months ago. He underwent percutaneous coronary intervention at the LAD and LCX 1 year ago with an Ultimaster 2.75 x 18 mm at the mid LAD, an Ultimaster 2.75 x 15mm at distal LM-LCX, and 2.75 x 15 mm at OM. The physical examination and electrocardiogram were unremarkable. Echocardiogram showed mild left ventricular systolic function without definite regional wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed diffuse ISR in the previous stent at mLAD, LM to pLCX and OM. ( Movie 1, Movie 2)
  2. The right coronary angiogram was normal. ( Movie 3)
Procedure
An 8 Fr sheath was inserted through right femoral artery and left coronary artery was engaged with an 8 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into dLCX and 0.014-inch BMW 190cm wire was inserted into LCX to OM. First pre-dilation was performed with a Sapphire NC 3.0 x 18 mm balloon at LM to pLCX and OM. IVUS showed ISR of the undersized stent at LM to OM ( Movie 4). Kissing balloon was performed with an Emerge 2.5 x 15 mm at the proximal LCX upto 10 atm (diameter 2.65) and IKAZUCHI zero 2.5 x 15 mm at OM upto 10 atm (diameter 2.62) ( Movie 5).

0.014-inch BMW 190 cm wire was inserted into the LAD. Balloon dilation with an IKAZUCHI zero 2.5 x 15 mm at the LAD was done first and IVUS was run, showing ISR at LAD ( Movie 6). We implanted a Xience Alpine stent sized 3.5 x 38 mm into the LM to proximal mid LAD ( Movie 7). The post stent balloon was performed with a Sapphire NC 3.0 x18 mm at the proximal to mid LAD and Powered Lacrosse 3.5 x 15 mm at the LM. Kissing balloon was performed with a Sapphire NC 3.0 x 18 mm at the proximal LCX upto 7 atm (diameter 2.9) and Powered Lacrosse 3.5 x 15 mm at pLAD upto 7 atm (diameter 3.31) ( Movie 8, Movie 9). The final IVUS and angiogram showed the successful result ( Movie 10, Movie 11).

Leave a comment

Sign in to leave a comment.