Percutaneous Coronary Intervention of an In-stent Restenosis, Utilising the Accuforce® Non-compliant PTCA Balloon Catheter for Optimisation of Stent Placement [report]

Lino Patricio, Renato Fernandes, Angelo Bento, David Neves
2018 unpublished
Man, 77 years old • Diabetes • Hypertension • Dyslipidaemia • Successful PCI of the left anterior descending (LAD) artery approximately 10 years earlier. Presentation • Stable angina • Proximal LAD: 70 % in-stent stenosis involving the ostium A 77-year-old man presented at the clinic with stable angina and a positive treadmill stress test. Around 10 years previously he had undergone PCI of the LAD. Coronary angiography revealed singlevessel disease in the proximal LAD, with 70 % in-stent
more » ... 0 % in-stent restenosis which involved the ostium (Figure 1). After discussion, it was decided to proceed with angioplasty. Procedure Access was obtained through the right radial artery using a 7 Fr Glidesheath Slender ® . Using an XB 3.5 7 Fr guide catheter, three Runthrough ® NS Hypercoat™ guidewires were advanced to the LAD, left circumflex (LCx), and ramus intermedius arteries. Optical frequency domain imaging (OFDI) was then performed to guide preparation of the lesion. OFDI showed significant in-stent restenosis in the LAD: 18 mm in length, with an inner lumen diameter distally measured as 1.3 mm (Figure 2) . The left main bifurcation was 4.2 mm in diameter, highlighting a significant mismatch between the proximal and distal luminal areas (Figure 3) . Pre-dilatation was performed using a 2.5 × 8 mm Accuforce noncompliant balloon at 20 atm, followed by a 3 × 10 mm Flextome™
doi:10.15420/rc.2018.m027 fatcat:vvg7avgo6zbhlhux3edidakwrq