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In-stent Restenosis in Ostial LAD Treated with a TAXUS Stent

- Operator : Charles Chan, MD, PhD, Singapore

Case Presentation
The patient was 43 year-old male admitted with exertional chest pain on August 2002. His coronary risk factors were hypertension and hyperlipidemia. His baseline coronary angiogram showed diffuse triple vessel disease. Therefore, he underwent multivessel PCI with a 3.0 20 mm ExpressTM stent for the proximal LAD lesion, a 3.0 12 mm ExpressTM stent for the LCX lesion, and a 3.0 8 mm ExpressTM stent for the proximal RCA lesion. However, he admitted again on January 2003 with chest pain.
Baseline Coronary Angiography
1. Left coronary angiogram showed diffuse in-stent restenosis in the proximal LAD and the narrowing was extended to distal LMCA (Figure 1, Figure 2).

2. The stent in RCA was patent.
Procedure
A 7 Fr sheath was inserted through right femoral artery and the left coronary was engaged with a 7 F XB catheter. Left main to LAD was wired with a 0.014 inch conventional wire. Although the left coronary angiogram showed intermediate lesion in distal LMCA, we decided to treat only the ostial LAD ISR lesion for prevention of ostial LCX narrowing after stenting. After cutting balloon angioplasty with a 2.5 10 mm cutting balloon, a 2.5 24 mm TAXUSTM stent was implanted for ostial LAD ISR (Figure 3). Final angiogram revealed very good result without a significant stent jail of LCX (Figure 4, Figure 5).
Unfortunately, he was readmitted with an anterior MI 5 days later. Coronary angiogram showed total occlusion in ostial LAD stent due to stent thrombosis (Figure 6). The lesion was treated with a 3.0 15 mm Quantum balloon while intravenous integrilin was infused (Figure 7). Final angiogram showed successful result with TIMI 3 flow (Figure 8).
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