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Treatment of a Recurrent ISR lesion of distal RCA
- Operator: Seung-Whan Lee, MD
Case Presentation
A 66 year-old gentleman was admitted due to effort chest pain for 6 months. Ten years ago, he underwent PCI at distal RCA (Arthos 4.0x14mm). One year later, he experienced ISR, which was treated by Sirolimus-eluting stent implantation. His coronary risk factors were hypertension, diabetes mellitus, hyperlipidemia, and ex-smoking. TMT was positive at stage 3 and thallium scan showed reversible large size perfusion defect at RCA territory.
Baseline coronary angiography
The right coronary angiogram showed tight stenosis at proximal edge and intermediate in-stent diffuse narrowing of dRCA stent ( Movie 1, Movie 2, Movie 3). The left coronary angiogram was normal.
Procedure
A 7 Fr JR 4.0 guiding catheter was engaged into the right coronary ostium. A 0.014 BMW wire was inserted into the RCA. Cutting balloon 3.0 x 10mm and Lacrosse 3.5 x 15mm balloon were sequentially dilated at proximal edge and in stent lesion (Figure 1, Figure 2, Figure 3, Figure 4). To cover the diffuse ISR lesion, we used 2 stents. We sequentially deployed Xience Prime stent 3.5 x 38mm and 3.5 x 18mm at the mid to distal ISR lesion of RCA (Figure 5, Figure 6). Thereafter, post-stenting adjunctive balloon dilatation was done using Lacrosse 3.5 x 15mm balloon. Final angiogram showed well-expanded and well-positioned stents ( Movie 4, Movie 5, Movie 6).
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