In-Stent Restenosis of Left Main Ostium Treated by Cutting Balloon Angioplasty followed by Sirolimus-Eluting stent

- Operator : Seong-Wook Park

In-Stent Restenosis of Left Main Ostium Treated by Cutting Balloon Angioplasty followed by Sirolimus-Eluting stent

- Operator : Seong-Wook Park, MD

Case Presentation
The patient was 37 year-old female admitted with effort chest pain for two months. She had stable angina and treated with a stent (Bx 3.5x8 mm) in left main ostium 6 months ago. She did not have any coronary risk factors. Base-line ECG showed normal. Thallium SPECT showed reversible perfusion defect in LM territory. Echocardiography showed good LV function with an EF of 62%.
Baseline Coronary Angiography
1. Baseline coronary angiogram showed in-stent restenosis at LMCA (Figure 1).

2. LCX and RCA were normal.
Intravascular ultrasound
IVUS image showed diffuse stenosis with neointima from LMCA ostium to shaft (Figure 2). not involving bifurcation (Figure 3). Stent CSA of narrowest segment was 7.28 mm.
Procedure
A 7F sheath was inserted through right femoral artery and the left coronary was engaged with a 7F Judikins catheter. Left main to LAD was wired with a 0.014 F guidewire. Cutting balloon angioplasty with a 3.25x10 mm balloon was performed two times at 8 atm (Figure 4), after then the LMCA ISR was stented with a 3.0 mm ¢¥ 8mm Cypher stent with 16 atm (Figure 5). Then, high pressure balloon dilation to achieve stent optimization was performed at 16 atm with a 3.5 x 9 mm conventional balloon (Figure 6). Final angiogram showed a good result (Figure 7). Final IVUS image showed stent CSA area was 7.89 mm2 (Figure 8).

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