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).

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