BMS-ISR at LAD Ostium Disease Treated with Drug-Eluting Balloon

- Operator : Alan C. Yeung

BMS-ISR at LAD Ostium Disease Treated with Drug-Eluting Balloon

- Operator: Alan C. Yeung, MD

Case Presentation

A 70-year-old man was admitted with efforting chest pain. His risk factor were hypertension and dyslipidemia. About 11 years ago, he received the implantation of S670 3.0 X 18mm at proximal LAD and Supra-G 3.0 X 15mm at distal LAD. He also received the implantation of Cypher 3.5 X 28mm at distal LM to proximal LAD, Cypher 3.5 X 18mm at distal LM to proximal LCX, and Cypher 2.75 X 18mm at OM. The EKG is normal and echocardiography showed normal left ventricular function (EF=56%) with regional wall motion abnormality of LAD and LCX territory.

Baseline Coronary Angiography

The left coronary angiography showed tight ISR at LAD ostium and total obstruction of LCX. ( Movie 1, Movie 2)

Procedure

A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 7Fr XB guiding catheter with 3.5cm curve. A 0.014 inch BMW and Runthrough wire were inserted into the LAD an LCX, respectively. After OCT and IVUS examination, Flextome cutting balloon 3.5 X 10mm was applied at ISR lesion of distal LM to pLAD. (Figure 1) After then, Drug-eluting balloon, Sequent Please 3.0 X 15mm was inflated over 30 seconds. ( Movie 3). The final left angiogram showed that the procedure was successful. ( Movie 4)