Rotational atherectomy is useful to treat the restenosis lesion of LCX after Culotte-Stenting to LMCA bifurcation lesion

- Operator : Hiroyuki Nagai

Rotational atherectomy is useful to treat the restenosis lesion of LCX after Culotte-Stenting to LMCA bifurcation lesion
- Operator: Hiroyuki Nagai, MD
Relevant clinical history and physical exam

A 57 year-old gentleman visited our hospital because of recurrent chest pain. His coronary risk factors were hypertension, dyslipidemia, and diabetes. He already underwent several PCIs for RCA, LAD, and LCX. Three years ago, he received the implantation of Cypher stent (3.5*23, 3.0*28, 2.5*8) at mdRCA and Cyper stent (3.0*28) at mLAD. And 1 year ago, Taxus stent 3.0*16 at dLAD, Taxus stent 2.5*32 at dLCX were implanted. Nine months before, Cypher 3.0*18 at dRCA was implanted again.

Relevant catheterization findings

Left coronary angiogram showed severe stenosis in LCX and LAD ostium (Figure 1, Figure 2).

Procedural step

Culotte steting for LMCA was performed. Cypher stent (3.5*33) was placed in LMCA-LAD. And Cypher stent (3.0*28) was placed in LMCA-LCX. Successful dilatation was obtained (Figure 3, Figure 4). However, 6 month later, follow up angiogram showed restenosis at LCX ostium, which was jailed by the Cypher stent implanted from LMCA to LAD (Figure 5, Figure 6). We slowly and gently advanced 2-mm and 2.25-mm burr without reducing the rotational speed by more than 5,000 rpm to ablate the stent struts which was obstacle for the LCX ostium ( Movie 1, Movie 2, Figure 7). After ablating stent struts, We dilated LCX ostium. Balloon size was 3.75mm. Maximum EEM diameter was 4.3mm in LCX ostium by IVUS. And we dilated LMCA, LAD, LCX with kissing balloon technique (Figure 8). The dilatation after culotte stenting showed napkin ring like a figure, because the maximum dilation diameter of SES struts is 2.75 mm. After kissing balloon technique, successful dilatation was obtained in LMCA, proximal LAD and LCX ( Movie 3, Movie 4). Three months later, there was no restenosis ( Movie 5, Movie 6).

Leave a comment

Sign in to leave a comment.