Case

Cypher Stent Implantation for Recurrent In-Stent Restenosis after Brachytherapy #1

- Operator : Seong-Wook Park

Cypher Stent Implantation for Recurrent In-Stent Restenosis after Brachytherapy #1
- Operator: Seong-Wook Park, MD, PhD, Korea
Case presentation
A 48-year old male patient was admitted due to effort chest pain for 2 months. His risk factor was hypercholestrolemia. Eight months ago, the patient had received brachytherapy with a 188Re-MAG3-filled balloon (18 Gy at 1 mm depth) after cutting balloon angioplasty for diffuse in-stent restenosis (Supra-G 3.0 x 15 mm) at the middle segment of LAD.(Figure 1, Figure 2, Figure 3, Figure 4 ) The follow-up coronary angiography revealed a tight restenosis of previous irradiated segment.(Figure 5) Therefore, we decided to treat this complex lesion with a Cypher stent.
Procedure
A 7F Judkins guiding catheter was engaged at the ostium of LCA. A Floppy guidewire was placed into LAD. The LAD lesion was dilated twice using a 3.5 x 10mm cutting balloon at 10 atm.(Figure 6) After cutting balloon angioplasty, the lesion was treated with a 3.5 x 23mm Cypher stent implantation at 16 atm.(Figure 7) Final angiography showed a good result.(Figure 8) At 6 months, the patient was free of angina, and follow-up angiography showed a patent stent at the middle segment of LAD.(Figure 9)

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