Korean Circ J.  2011 Nov;41(11):677-680. 10.4070/kcj.2011.41.11.677.

Drug-Eluting Stent as an Option for Intractable In-Stent Coronary Restenosis

• Hachinohe
• Jeong MH
• Kim MC
• Cho KH
• Ahmed K
• Hwang SH
• Lee MG
• Sim DS
• Park KH
• Kim JH
• Hong YJ
• Ahn Y
• Kang JC

• KMID: 2225078
• DOI: http://doi.org/10.4070/kcj.2011.41.11.677

Abstract

A 51-year-old man was admitted due to an acute anterior ST-segment elevation myocardial infarction. After thrombolytic therapy using recombinant tissue plasminogen activator, stent implantation was performed from the proximal left anterior descending artery (LAD) to the mid LAD using a bare-metal stent (BMS). Since then, the patient suffered five repeated episodes of in-stent restenosis (ISR). At the first ISR, he was treated with plain old balloon angioplasty (POBA). At the second ISR, he was treated with brachytherapy, and at the third ISR, he was treated with POBA and one more BMS distal to the previously implanted stent. At the forth, only POBA was performed, and finally, at the fifth ISR, a sirolimus-eluting stent was implanted. Following that, the patient remained asymptomatic and follow-up coronary angiography showed no ISR.

Keyword

Drug-eluting stents; Coronary restenosis; Brachytherapy; Angioplasty

MeSH Terms

Angioplasty
Angioplasty, Balloon
Arteries
Brachytherapy
Coronary Angiography
Coronary Restenosis
Drug-Eluting Stents
Follow-Up Studies
Humans
Middle Aged
Myocardial Infarction
Stents
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

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  Fig. 1 A diagnostic coronary angiogram (CAG) revealed successful thrombolysis status but a critical stenosis of the proximal and mid left descending artery. After successful stent implantation using a 3.0×27 mm bare-metal stent, final CAG showed no residual stenosis with good distal flow.

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  Fig. 2 Second in-stent restenosis (ISR). A coronary angiogram (CAG) revealed type II ISR. Brachytherapy with Rhenium was performed for 300 seconds at 6 atm using a 3.0×20 mm balloon. Final CAG showed no residual stenosis with good distal flow.

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  Fig. 3 Third in-stent restenosis (ISR). A coronary angiogram (CAG) revealed type IV ISR secondary to brachytherapy failure. Plain old balloon angioplasty using a 3.0×20 mm balloon and 3.0×18 mm bare-metal stent implantation distal to previously implanted stent was performed. Final CAG showed no residual stenosis with good distal flow.

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  Fig. 4 Fifth in-stent restenosis (ISR). A coronary angiogram (CAG) revealed type II ISR in proximal and mid left anterior descending artery stent. A 3.0×33 mm Cypher stent® (Cordis Johnson & Johnson) was inplanted. Final CAG showed no residual stenosis with good distal flow.

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  Fig. 5 On follow-up coronary angiogram performed one week after stenting, the stent in the left anterior descending artery was patent without narrowing of the ostium of left circumflex and distal left main artery.

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