Slides Coronary In-stent Restenosis

Bare Metal Stent In-Stent Restenosis

- Operator : Maurice Buchbinder

Bare Metal Stent In-Stent Restenosis
- Operator: Maurice Buchbinder, MD
Case Presentation
A 66 year-old man was admitted with effort chest pain. About 14 years ago, he underwent PCI at proximal LAD with rotational atherectomy and GFX 4.0x12mm. His coronary risk factors were hypertension, hyperlipidemia and current smoker. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=61%) without regional wall motion abnormality. Treadmill test and thallium test were not done.
Baseline coronary angiography
The left coronary angiogram showed diffuse and tight in-stent restenosis at proximal to middle LAD and total occlusion of LCX ( Movie 1, Movie 2). The right coronary angiogram showed diffuse stenosis at proximal to distal RCA. Before LAD PCI, we firstly implanted Xience stent 4.0 x 38mm and 4.0 x 38mm at proximal to middle RCA, and Xience 3.5 x 28mm at distal RCA ( Movie 3, Movie 4).
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F EBU 4.0 catheter with side hole. A 0.014 inch BMW wire was inserted into the LAD. Predilatation was performed with a 3.0 x 20mm Voyager balloon at proximal to middle LAD (Figure 1, Figure 2, Figure 3). After predilatation, three Promus Element stents (3.0x20mm, 3.0x28mm and 3.0x28mm) were implanted at proximal to middle LAD with overlapping (Figure 4, Figure 5, Figure 6). And then, postdilatation using a 3.5 x 20mm Quantum balloon at proximal to middle LAD was performed. Final angiogram showed well-expanded stents without residual narrowing ( Movie 5).

Comments

  • Kunal Bikram Shaha 2016-08-12 sir why were three stents used instead of one long and a short stent in this case as the size was 3.0
  • Se Hun Kang 2016-08-12 Thank you for your comment. As you saw, there was diffuse stenosis form proximal to mid LAD. So we had to put two stent with length of 28 mm. Considering the overlapping area, the lesion length was more than 50 mm. Currently the longest stent is only 40 mm. Therefore we had to put two stent with overlapping to treat the stenosis of LAD.

Leave a comment

Sign in to leave a comment.