Case

In-Stent Restenosis Lesion Treated by Drug-Coated Balloon

- Operator : Seung-Jung Park

In-Stent Restenosis Lesion Treated by Drug-Coated Balloon
- Operator: Seung-Jung Park, MD
Case Presentation
A 77-year-old female was admitted for effort angina. Her coronary risk factors were hypertension and diabetes. She received PCI with bare-metal stents at proximal and mid LAD 20 years ago. Her coronary angiogram showed diffuse moderate stenosis at RCA and severe in-stent restenosis at mLAD. Thallium SPECT showed fixed medium sized perfusion defect in mid-basal anteroseptal wall. Echocardiography revealed normal LV systolic function with RWMA in LAD territory.
Baseline Coronary Angiogram
  1. The right coronary angiogram showed diffuse moderate at proximal to mid RCA with heavy calcification and severe tortiousity ( Movie 1).
  2. The left coronary angiogram showed diminutive LCX and in-stent restenosis at mid LAD stent with positive FFR results (0.78 with IV adenosine, Movie 2).
Procedure
A 7 Fr Terumo¢ē sheath was inserted through the right femoral artery and left coronary artery was engaged with an 7 Fr XB 3.5 guiding catheter. The BMW wire, 0.014-inch 190 cm was inserted into the LAD. OCT was performed in order to check the pathology of ISR, which demonstrated soft atheroma with neointimal hyperplasia ( Movie 3). After balloon dilatation at the mLAD was performed with Tazuna 2.5 x 15 mm balloon, Flextome Cutting Balloon was applied for pre-lesion modification (Figure 1). Post-balloon OCT was revealed balloon dissection at the distal edge of previous stent ( Movie 4, Movie 5). The patient developed severe chest pain with ST elevation and BP drop. We decided to deploy the DES at distal to the previous stent (Figure 2). After successful stenting, Drug-Coated Balloon (SeQuent Please 3.0 x 30 mm) was applied for ISR at pmLAD (Figure 3). Then additional balloon dilatation was done with Tazuna 2.5 x 15 mm balloon. The final OCT and angiogram showed successful results ( Movie 6, Movie 7).

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