Slides

BMS and Radiotherapy Failure

- Operator : Ron Waksman

BMS and Radiotherapy Failure
- Operators: Ron Waksman, MD, Junbo Ge, MD
Clinical Information

- Relevant clinical history and physical exam:
A 76-year-old man was admitted with accelerating effort chest pain. 9 years ago, he was diagnosed of unstable angina and PTCA was done for LAD stenosis. After 5 months, he was readmitted with effort chest pain and brachytherapy was applied for the BMS ISR lesion. ECG showed non-specific finding, and biomarker was within normal range

- Relevant test results prior to catheterization:
Echocardiography showed normal LV systolic function with basal inferoposterior hypokinesia
Thalium spect showed reversible large sized defect in LAD territory

- Relevant angiography findings:
Coronary angiogram showed the proximal RCA tubular stenosis and significant diffuse ISR in previous stent site of LAD. (Figure 1)
Interventional Management
- Procedural step:
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB guiding catheter with 4.0cm curve. A 0.014 inch BMW wire was inserted into the LAD and the LCX respectively. Proximal to mid LAD ISR were dilated with 3.0 X 12mm Quantum balloon six times.(Figure 2) Follow-up angiogram showed the disappearance of second diagonal branch.(Figure 3) Patients suffered from chest pain. A 0.014 inch Runthrough NS wire was inserted into the diagonal branch. Diagonal ostium was dilated with Maveric ballon 2.0 X 15mm.(Figure 4) Final left angiogram showed that the procedure was successful.(Figure 5)

Comments

  • Orazbek Sakhov 2009-09-19 What do you think about necessity of postdilatation inside stent or kissing balloon?

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