1: Restenosis of a Drug-Eluting Stent

CASE 1 Restenosis of a Drug-Eluting Stent




Case presentation


A 53-year-old man, with hypertension, dyslipidemia, and a history of multiple prior percutaneous coronary interventions involving the proximal left anterior descending artery, presented to his physician with a 3-month history of progressively worsening exertional chest pressure and left arm pain, similar to his previous episodes of angina.


Two years earlier, he first developed classic effort angina. An abnormal stress test led to a coronary angiogram, which revealed a severe stenosis in the proximal segment of the left anterior descending coronary artery (Figure 1-1 and Video 1-1). This was treated with a 3.0 mm diameter by 23 mm long sirolimus-eluting stent, with an excellent angiographic result (Figure 1-2 and Video 1-2). His angina completely resolved; however, 10 months after the procedure, he developed recurrent effort angina. Coronary angiography confirmed severe, focal, in-stent restenosis within the proximal edge of the drug-eluting stent (Figure 1-3). Balloon angioplasty using a 3.0 mm noncompliant balloon dilated to 16 atmospheres improved the angiographic appearance (Figure 1-4 and Video 1-3) and resolved the patient’s symptoms. However, 6 months later (and 9 months before his current presentation) the development of recurrent angina prompted another angiogram. A second recurrence of in-stent restenosis within the proximal left anterior descending artery stent (Figure 1-5 and Video 1-4) was treated with a 3.0 mm diameter by 30 mm long zotarolimus-eluting stent, again with good angiographic result (Figure 1-6A). Intravascular ultrasound performed after this procedure demonstrated excellent stent apposition throughout the stented segment (Figure 1-6B). He remained symptom-free for 6 months until this presentation.








Jun 11, 2016 | Posted by in CARDIOLOGY | Comments Off on 1: Restenosis of a Drug-Eluting Stent

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