LAD ISR Intervention with OCT Imaging

- Operator : Duk-Woo Park

LAD ISR Intervention with OCT Imaging
- Operator: Duk-Woo Park, MD
Case Presentation
A 53-year-old male was admitted for exertional chest pain. He had previous PCI history at proximal to mid LAD with BVS absorb 3.0 (18) and 2.5 (18). Physical examination and a simple chest radiograph were unremarkable. Echocardiogram showed normal LV function without wall motion abnormality.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed diffuse 70-80% stenotic lesion at proximal to mid LAD and normal pLCX ( Movie 1, Movie 2).
  2. The right coronary angiogram showed nearly normal with collateral flow from PDA to septal branch ( Movie 3).
A 7 Fr femoral sheath (Terumo®) was inserted through the right femoral artery and left coronary artery was engaged with a 7 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire and 0.014-inch Sion blue wire were inserted into LAD and diagonal branch, respectively. Before the intervention, OCT was used to identify lesion characteristics and mechanism of ISR at LAD, in which diffuse neointimal hyperplasia through the stent strut of BVS was identified with OCT imaging evaluation ( Movie 4). Lesion modification with non-compliance 3.0 x 15 mm balloon was used. Two Xience Sierra stents sized 3.0 x 23 mm and 3.5 x 28 mm at LAD ISR lesion were inserted. NC Emerge balloon sized 3.0 x 15 mm was used for stent optimization. OCT was checked and showed no immediate complications with adequate stent area ( Movie 5). The final angiogram showed no stenotic lesion and good flow ( Movie 6).

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