The Treatment of ISR at pLCX using Drug Eluting Balloon

- Operator : Seung-Jung Park

The Treatment of ISR at pLCX using Drug Eluting Balloon
- Operator: Seung-Jung Park, MD
Relevant clinical history and physical exam
A 69 year-old gentleman visited our hospital because of recurrent episodes of angina. He already underwent PCI with Cypher 3.5 x 33 mm stent at LM-pLAD 2 years ago and with Xience V 3.0 x 23 mm stent at pLCX 1 year ago, respectively. Treadmill exercise test showed ST depression at stage 4. He had hypertension and diabetes.
Relevant catheterization findings
The left coronary angiogram showed tight ISR of pLCX stent and patent LM-pLAD stent ( Movie 1). The right coronary artery showed normal angiogram.
Procedural step
A JL3.5 SH 8Fr guiding catheter was engaged into the left coronary artery through the right femoral artery. A 0.014-inch BMW wire and another 0.014-inch BMW wire were inserted into the LAD and LCX, respectively. First above all, we dilated ISR lesion of pLCX using a 3.0 x 10 mm cutting balloon (Figure 1). Thereafter, kissing balloon inflation was performed using a Dura Star 3.5 x 15 mm at LM-pLAD and a Dura Star 3.0 x 15 mm at pLCX (Figure 2). Subsequently, we performed drug eluting balloon inflation (SeQuent Please 2.75 x 20 mm) at pLCX (Figure 3). Final angiogram showed no residual in-stent narrowing in pLCX stent ( Movie 2).

Comments

  • Garry Barron 2011-10-15 Any plans to repeat angiogram or stress test?
  • Young-Hak Kim 2011-10-17 A routine angiographic follow-up is not always indicated after left main PCI. But, a surveillance using coronary CT or stress test will be required.
  • Zhonghan Ni 2011-10-18 Dr,why did you select a 2.75*20mm DEB instead of a 3.0mm diameter one,since the inserted stent one year ago was a 3.0*23mm Xience V? do you think that the different diameter DEB may make different outcomes in the future?
  • Young-Hak Kim 2011-10-19 The balloon size was selected by the IVUS findings.
  • Marcelo Ribeiro 2011-10-24 As we perform POBA for in stent restenosis, sometimes we see a pristine angiographic result after the dilatation, although other times the result just do not shown up, as like the restenotic material drops down again immediately after the balloon deflation- this happens more commonly in diffuse restenotic lesions. In this specific case what would be your approach if facing this hypothetical scenario?
  • Young-Hak Kim 2011-10-24 In diffuse restenosis, we prefer to use repeated DES implantation. Balloon angioplasty cannnot work well in diffuse lesions.
  • Joao Alexandre Farjalla 2011-11-24 Good final result!!! Aren¢¥t you afraid of restenotic lesion in LM-pLAD after kissing balloon?
  • Long Bui 2012-01-27 What is the restenosis rate after DEB treatment?

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