DES-ISR at LCX ostium; How about Treatment of Drug-Eluting Balloon?

- Operator : Raj Makkar

DES-ISR at LCX ostium; How about Treatment of Drug-Eluting Balloon?

- Operator: Raj Makkar, MD

Relevant clinical history and physical exam

A 48-year-old man was admitted to our hospital for treatment of CAD. 7 month ago, he had got PCI on LMCA bifurcation disease with mini-Crush technique.(Xience V stent 35 X 28 mm and 2.75 X 28 mm at LM-pLAD, Xience V stent 3.0 X 28 mm at pLCX) and proximal to mid RCA(Xience stent V 4.0 X 28 mm and Xience V 4.0 X 23 mm). His risk factor was hyperlipidemia and he is ex-smoker. His current medications were anti-angina medication, antihypertensive medications and lipid lowering agents.

Relevant test results prior to catheterization

Electrocardiogram showed Q wave in anterior leads. And echocardiogram showed normal LV ejection fraction without regional wall motion abnormalities.

Relevant angiography findings

Follow-up of coronary angiogram showed tight in-stent restenosis at the LCX ostium( Movie 1). FFR showed that the lesion in LCX ostium was significant.(0.52).

Procedure

Dr. Raj Makkar selected 8Fr XB 3.5 guiding catheter to engage LMCA and inserted a 0.014 inch BMW wire into the LCX. Intravascular ultrasound was initially performed, showed that extensive tissue growing with tight stenosis at the ostial part of LCX stent ( Movie 2). He got to inflate cutting balloon with 3.0 X 10 mm at 12 atm. Finally, Drug-eluting balloon, SeQuent please 3.0 X 20mm was inflated at 7 atm over 30 seconds( Movie 3). The final result was excellent( Movie 4).