J Cardiovasc Interv.  2023 Jan;2(1):44-49. 10.54912/jci.2022.0020.

Early In-Stent Restenosis of Right Coronary Artery Ostium by Calcified Nodule

• Lim HJ
• Kang SH

• KMID: 2561264
• DOI: http://doi.org/10.54912/jci.2022.0020

Abstract

Percutaneous coronary intervention (PCI) of severely calcified lesions is one of the most challenging procedures in interventional cardiology. Coronary calcification is a risk factor for stent under-expansion and stent failure. Although calcified nodule (CN) within the stent has been reported as one of the causes of in-stent restenosis (ISR), the occurrence rate is relatively low, and the optimal therapy for these lesions is not clear. The patient was a 67-year-old man. He previously underwent PCI for the left main ostial and right coronary artery (RCA) ostial lesion. Intravascular ultrasound showed a CN in the RCA. He underwent coronary angiography 6 months later, and an ISR lesion was observed at RCA ostium. IVUS showed a CN protruding into the coronary lumen through the stent struts in the ISR lesion. After aggressive lesion modification with a larger non-compliant balloon, additional stent was implanted at RCA ostium. After stent implantation, IVUS showed no CN protrusion into coronary lumen. It doesn`t occur often, however CN protrusion into the coronary lumen through stent struts without stent fracture might cause ISR, relatively early after PCI. Although the optimal treatment strategy is unclear, considering mechanism for ISR by CN is necessary for proper treatment, and lesion preparation with a larger non-compliant balloon may be a treatment option.

Keyword

Coronary artery disease; Percutaneous coronary intervention; Coronary restenosis