IIn-Stent Restenosis in Ostial to Mid RCA Treated with a Cypher Stent

- Operator : Thierry Lefevre

IIn-Stent Restenosis in Ostial to Mid RCA Treated with a Cypher Stent
- Operators: Thierry Lefèvre, MD, Robaayah Zambahari, MD
Case presentation

9 months ago, a 66-year-old woman was admitted with accelerating effort chest pain. Coronary angiogram showed signficant stenosis of RCA and LAD and DESs(Cypher) were applied for those lesion. She has been doing well but follow- up angiogram showed significant stenotic lesion on RCA. ECG showed non-specific finding, and biomarker was within normal range. She has a diabetes, hypertension and dyslipidemia.
The echocardiography revealed no regional wall motion abnormality with normal LV systolic function. Stress test was not done.

Baseline Coronary Angiography

Coronary angiogram showed significant ISR on previous stent site of right coronary artery and significant stenosis of proximal left circumflex coronary artery

Procedure
A 7 Fr sheath was inserted through right femoral artery and the right coronary was engaged with a 6 F JR 3.5 catheter. RCA was wired with a 0.014 inch conventional wire (BMW). The right coronary angiogram showed tight stenosis in RCA on and also significant stenosis of mRCA (Figure 1, Figure 2). After wiring, we performed IVUS exam from RCA os to mRCA. The IVUS finding shows significant intimal growth in whole in-stent lesion especially ostium without any stent fracture. Therefore, we performed stenting using 3.5 x 23 Cypher stent in RCA os (Figure 3, Figure 4)and 3.5 x 23 Cypher stent in mRCA with overlapping directly. And then, postdilation was performed using stent balloon. Final angiogram showed successful result with TIMI 3 flow (Figure 5, Figure 6).

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