Figure 13.1
Baseline angiographic images of the left coronary system showing mild to moderate nonobstructive disease
Figure 13.2
Fluoroscopy image of RCA without contrast showing previously placed stents (black arrows demonstrating outline of stented artery)
Figure 13.3
Angiography of RCA showing severe in-stent restenosis of proximal and mid-RCA delineated with black arrows
A 0.014 guidewire was placed beyond the mid-RCA lesion, and the wire was then exchanged for a 0.014 Extra Support guidewire. Rotational atherectomy was performed using a 1.25 mm burr, with multiple passes made (Fig. 13.4). The rotational atherectomy system was then exchanged for a 1.5 mm burr, and more passes were made (Fig. 13.5). Repeat angiography revealed improved but residual luminal narrowing (Fig. 13.6), and the proximal and mid-RCA lesions were dilated with a scoring balloon (Fig. 13.7a, b). Over the wire, a 3.5 × 38 mm DES was deployed (Fig. 13.7c) and post-dilated with a 4.0 × 12 mm noncompliant balloon (Fig. 13.7d). Final angiographic pictures revealed excellent results (Fig. 13.8) with TIMI-3 flow. There were no complications.
