TY  - CHAP
M1  - Book, Section
TI  - In-Stent Restenosis
A1  - Alraies, M. Chadi
A1  - Waksman, Ron
A2  - Baliga, R. R.
A2  - Lilly, Scott M.
A2  - Abraham, William T.
PY  - 2018
T2  - Color Atlas and Synopsis of Interventional Cardiology
AB  - A  67-year-old  man  with  a  past  medical  history  significant  for  insulin-dependent  diabetes  mellitus,  hypertension,  and  coronary  artery  disease  was  admitted  with  typical  angina  (Canadian  Cardiovascular  Society  [CCS]  class  III)  for  1  month.  The  patient  had  a  history  of  acute  non–ST-segment  elevation  myocardial  infarction  (NSTEMI)  12  months  prior  to  his  presentation  and  was  treated  with  a  total  of  5  drug-eluting  stents  in  the  left  anterior  descending  (LAD),  left  circumflex  (LCx),  and  right  coronary  (RCA)  arteries.  The  patient  was  compliant  with  dual  antiplatelet  therapy  (DAPT)  after  percutaneous  coronary  intervention  (PCI).  During  the  current  admission,  the  patient  had  dynamic  electrocardiogram  (ECG)  changes  in  anterolateral  leads  with  elevated  troponin  I.  Echocardiography  revealed  a  hypokinetic  left  ventricular  (LV)  apex  with  estimated  left  ventricular  ejection  fraction  (LVEF)  of  45%.  The  patient  underwent  coronary  angiogram  that  showed  severe  diffuse  in-stent  restenosis  (ISR)  in  the  proximal  LAD  stent  and  moderate  ISR  in  the  diagonal  stent  (bifurcation  lesion)  along  with  significant  ostial  disease  in  the  LAD  extending  from  the  upper  edge  of  the  LAD  stent.  Kissing  balloon  inflations  were  performed  using  a  2.5  ×  15  mm  sapphire  noncompliant  (NC)  balloon  in  the  LAD  and  a  2  ×  10  mm  sapphire  balloon  in  the  diagonal  branch.  Keeping  the  guidewire  in  the  LAD,  the  LCx  was  wired  using  a  BMW  guidewire.  A  Xience  V  (Abbott,  Chicago,  IL)  2.75  ×  12  mm  stent  was  positioned  in  the  ostioproximal  LAD  overlapping  the  distal  stented  segment  (see  Figure  17-3,  red  arrow)  and  deployed  at  18  atm,  keeping  an  uninflated  2  ×  10  mm  sapphire  balloon  in  the  distal  left  main  and  ostial  LCx.  The  overlapped  segment  was  postdilated  using  the  same  in-stent  balloon  at  20  atm.  Thrombolysis  in  Myocardial  Infarction  (TIMI)  grade  3  flow  was  achieved  in  the  LAD  without  any  compromise  of  ostial  LCx.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesscardiology.mhmedical.com/content.aspx?aid=1160206886
ER  -