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The Treatment of ISR at pLCX using Drug Eluting Balloon
- Operator: Seung-Jung Park, MD
Relevant clinical history and physical exam
A 69 year-old gentleman visited our hospital because of recurrent episodes of angina. He already underwent PCI with Cypher 3.5 x 33 mm stent at LM-pLAD 2 years ago and with Xience V 3.0 x 23 mm stent at pLCX 1 year ago, respectively. Treadmill exercise test showed ST depression at stage 4. He had hypertension and diabetes.
Relevant catheterization findings
The left coronary angiogram showed tight ISR of pLCX stent and patent LM-pLAD stent ( Movie 1). The right coronary artery showed normal angiogram.
Procedural step
A JL3.5 SH 8Fr guiding catheter was engaged into the left coronary artery through the right femoral artery. A 0.014-inch BMW wire and another 0.014-inch BMW wire were inserted into the LAD and LCX, respectively. First above all, we dilated ISR lesion of pLCX using a 3.0 x 10 mm cutting balloon (Figure 1). Thereafter, kissing balloon inflation was performed using a Dura Star 3.5 x 15 mm at LM-pLAD and a Dura Star 3.0 x 15 mm at pLCX (Figure 2). Subsequently, we performed drug eluting balloon inflation (SeQuent Please 2.75 x 20 mm) at pLCX (Figure 3). Final angiogram showed no residual in-stent narrowing in pLCX stent ( Movie 2).
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