| A 49-year old male patient was admitted due to exertional
chest pain for 2 months. His risk factor was hypertension and smoking. The
echocardiography revealed akinesia of LAD territory without wall thining
and thallium SPECT showed fixed perfusion defect at mid to apical antero-septal
wall. The patient had been treated with a 3.0x 25 mm Crossflex stent at
th middle segment of LAD. Six months after stent implatation, the patient
was readmitted for chest pain, and received brachytherapy with a 188Re-MAG3
filled-conventional balloon in size and length of 3 x 40 mm (15 Gy at 1
mm depth) for diffuse in-stent restenosis (ISR) (Figure
1: stented segment, Figure
2: ISR) in the middle segment of LAD after rotational atherectomy (Figure
3: rotational atherectomy,
Figure 4: brachytherapy, Figure
5: final result). The irradiated lesion had been patent at 6-month follow-up
angiogram after brachytherapy (Figure
6) with a mild narrowing at the edge portion of the stent. The routine
2-year follow-up study was performed to evaluate fate of the patent irradiated
segment at 6 months. It showed a progressive luminal narrowing at the irradiated
segment, preserving luminal patency (Figure
7). The routine 5-year follow-up study was also done, which showed a
total occlusion at the irradiated segment (Figure
8). The patient did not have ischemic symptoms and follow-up thallium
SPECT showed no significant interval change. Therefore, medical treatment
has been continued. |
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