Slides Coronary In-stent Restenosis

Intervention of BMS Diffuse ISR Using DES

- Operator : Takeshi Kimura

Intervention of BMS Diffuse ISR Using DES
- Operators: Takeshi Kimura, MD, Duncan Hung Kwong Ho,MD
Clinical Information

- Relevant clinical history and physical exam:
A 50-year-old man was admitted with chest pain for six months. Twelve years ago, he had diagnosed of acute myocardial infarction and BMS were applied for the middle LAD and distal RCA lesion. Recently he suffered from chest pain, and coronary angiography showed significant stenosis at middle LAD lesion.

- Relevant angiography findings:
Coronary angiogram showed significant stenosis at proximal left circumflex coronary artery (figure 1) and previous bare metal stent site on middle left anterior descending artery (figure 2, figure 3, figure 4).

Interventional Management
- Procedural step:
A 8 Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB guiding catheter with 3.5cm curve. A 0.014 inch BMW wires were inserted into the LAD and LCX respectively. IVUS was performed about LAD, and LCX lesions, and revealed significant stenosis at both arteries. In addition, FFR showed significant flow limitation at LAD (FFR = 0.66) and borderline limitation at LCX (FFR = 0.77). At first, Xience V 3.0 x 23 mm and 3.0 x 12 mm were deployed at middle LAD ISR lesion after predilatation (figure 5, figure 6). Then, a 3.0 X 18 mm Xience stent was positioned at the proximal LCX. Unfortunately, a dissection was developed at stent distal portion (figure 7), and a 2.75 x 15 mm Xience stent was placed at the distal LCX (figure 8). However, additional stent could not cross the lesion even using anchoring technique. Because flow was not so bad, we finished procedure (figure 9).

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