Slides
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 |
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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. |
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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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