Slides
Intervention of DES ISR Using High-Pressure Inflation of Non-Compliant Balloon
- Operator : Ron Waksman
| Intervention of DES ISR Using High-Pressure Inflation of Non-Compliant Balloon |
| - Operator: Ron Waksman, MD |
| Clinical presentation |
| A 61-year old man was admitted with effort chest pain for 1 week. Two years ago, he underwent BMS stentings at distal RCA (Tsunami 3.0 X 20 mm) and mid-LAD lesions (Taxus 3.0 X 24 mm). Two months later, he received Cypher 3.5 X 23mm implantation for a diffuse ISR of distal RCA at other hospital. His risk factor was hypertension. Baseline ECG showed normal finding. Echocardiography showed normal LV systolic function without regional wall motion abnormality. |
| Baseline coronary angiogram |
|
1. Left coronary angiogram showed patent stent of mid-LAD (Figure
1 and Figure 2). 2. Right coronary angiogram showed diffuse ISR at distal RCA (Figure 3 and Figure 4). |
| Procedure |
| A 7 Fr sheath was inserted through right femoral artery, and the right coronary ostium was engaged with a 7 Fr hockey-stick catheter. A 0.014 inch BMW wire was inserted into the posterolateral branch. Predilation was firstly performed using a 3.0 X 20 mm Maverick balloon at 18atm (3.55 mm) from the distal portion of ISR to de novo native lesion of distal RCA (Figure 5) and a 3.5 X 12 mm Quantum balloon at 20 atm (3.66 mm) for in-stent lesion (Figure 6 and Figure 7). Two Taxus stents (3.5 X 24 and 3.0 X 24 mm) were deployed consecutively from in-stent lesion to native lesion of distal RCA at 20atm (4.0 and 3.4 mm) (Figure 8 and Figure 9). Additional balloon was done using 4.0 X 12 mm Quantum balloon upto 20 atm (4.2 mm), repetitively (Figure 10). Final angiogram showed a well-expanded stents without residual narrowing (Figure 11 and Figure 12). |
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