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Cypher Stent Implantation for Recurrent In-Stent Restenosis after Brachytherapy #2
- Operator : Myeong-Ki Hong, MD, PhD, Korea
The patient was a 49 year-old man. In September 2002, he was treated with a 3.5 x 18 mm S7 stent for a LAD stenosis.(Figure 1, Figure 2) His coronary risk factors were hypertension and smoking. Echocardiogram showed 50% of left ventricular ejection fraction with regional wall motion abnormalities in LAD territories. Six-month follow-up coronary angiogram showed a total in-stent restenosis (ISR) at the stented segment.(Figure 3) The ISR lesion was treated with cutting balloon angioplasty (Figure 4) and beta-radiation with a 188Re-MAG3 filled balloon.(Figure 5) Final angiogram was successful.(Figure 6) Although he had not ischemic symptoms, 6-month follow-up angiogram showed a recurrent in-stent restenosis at the radiated segment and a new lesion at the distal LAD.(Figure 7) Because the ISR lesion was refractory to the first brachytherapy treatment, we intended to treat the lesion with a Cypher stent. After a 3.0 x 18 mm Cypher stent implantation for the distal LAD lesion,(Figure 8) balloon angioplasty followed by a 3.0 x 18 mm Cyhper stent implantation was performed at the recurrent ISR lesion.(Figure 9) Final angiogram showed a very good result.(Figure 10)
During 3-month follow-up period, he has not complained any cardiac symptoms.
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