Slides
RCA ISR Lesion Treated with Everolimus-Eluting Stents
- Operator : Maurice Buchbinder
| RCA ISR Lesion Treated with Everolimus-Eluting Stents |
| - Operators: Maurice Buchbinder, Hyeon-Cheol Gwon |
| Clinical presentation |
| A 66-year old man was referred from other hospital with ISR of proximal-middle RCA without symptom. About 1-year ago, he was implanted sirolimus-eluting stents at middle LAD and distal LCX, zotarolimus stent at proximal RCA. His coronary risk factors were diabetes, hypertension and hyperlipidemia. Baseline ECG showed no ischemic change. Echocardiography revealed no regional wall motion abnormality with normal LV systolic function |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed patent previous
stent at middle LAD and distal LCX (Figure
1) |
| Procedure |
| A 8Fr sheath was inserted into the right femoral
artery. The right coronary ostium was engaged with a 8Fr AL1 guiding catheter.
A 0.014 inch BMW wire was inserted into the RCA. The BMW couldn’t
pass the stenotic lesion. We changed wire 4 times (Whisper, Miracle 3, and
Choice PT), finally we could insert the wire into RCA with Choice PT (Figure
3). Pre-dilation was performed with 1.5 X 20 mm Maverick by 8 atm (1.58
mm) (Figure
4). Then pre-dilation was performed again with 3.0 X 20 mm Maverick
by 6 atm (3.0 mm) (Figure
5). Then high-pressure balloon dilation was performed with same balloon
by 12 atm (3.81 mm). IVUS study was done about RCA ISR lesion (Figure
6). The 3.0 X 18 mm Promus stent was positioned in middle to distal RCA by 12 atm(3.15 mm) (Figure 7). And the 3.0 X 28 mm Promus stent was positioned in proximal to middle RCA (Figure 8). Additional balloon was performed with 3.0 X 28 mm stent balloon by 14 atm (3.23 mm). Final additional post stent balloon was performed with 3.5 X 12 mm Quantum by 18 atm (3.62 mm). Final right angiogram showed that the procedure was successful (Figure 9). |
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