Intervention of DES ISR Using High-Pressure Inflation of Non-Compliant Balloon
- Operator: Ron Waksman, MD
Clinical presentation
A 61-year old man was admitted with effort chest pain for 1 week. Two years ago, he underwent BMS stentings at distal RCA (Tsunami 3.0 X 20 mm) and mid-LAD lesions (Taxus 3.0 X 24 mm). Two months later, he received Cypher 3.5 X 23mm implantation for a diffuse ISR of distal RCA at other hospital. His risk factor was hypertension. Baseline ECG showed normal finding. Echocardiography showed normal LV systolic function without regional wall motion abnormality.
Baseline coronary angiogram
1. Left coronary angiogram showed patent stent of mid-LAD (Figure
1 and Figure 2).
2. Right coronary angiogram showed diffuse ISR at distal RCA (Figure 3 and Figure 4).
Procedure
A 7 Fr sheath was inserted through right femoral artery, and the right coronary ostium was engaged with a 7 Fr hockey-stick catheter. A 0.014 inch BMW wire was inserted into the posterolateral branch. Predilation was firstly performed using a 3.0 X 20 mm Maverick balloon at 18atm (3.55 mm) from the distal portion of ISR to de novo native lesion of distal RCA (Figure 5) and a 3.5 X 12 mm Quantum balloon at 20 atm (3.66 mm) for in-stent lesion (Figure 6 and Figure 7). Two Taxus stents (3.5 X 24 and 3.0 X 24 mm) were deployed consecutively from in-stent lesion to native lesion of distal RCA at 20atm (4.0 and 3.4 mm) (Figure 8 and Figure 9). Additional balloon was done using 4.0 X 12 mm Quantum balloon upto 20 atm (4.2 mm), repetitively (Figure 10). Final angiogram showed a well-expanded stents without residual narrowing (Figure 11 and Figure 12).
