Coronary restenosis of in-stent protruding bump with rapid progression: Optical frequency domain imaging and angioscopic observation

Publication date: Available online 15 October 2018Source: Journal of Cardiology CasesAuthor(s): Kenji Kawai, Hirokuni Akahori, Takahiro Imanaka, Kojiro Miki, Nagataka Yoshihara, Koji Yanaka, Tohru Masuyama, Masaharu IshiharaAbstractIn-stent restenosis (ISR) remains a tough problem after percutaneous coronary intervention (PCI) despite advances in technology of drug-eluting stents (DES). A 63-year-old man undergoing hemodialysis was diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS). An emergency coronary angiography (CAG) revealed severe stenosis in the middle left circumflex artery (LCx). After pre-dilatation with non-compliant balloon, primary PCI was successfully performed with DES implantation. Four months after, CAG was performed again and verified ISR of LCx under diagnosis of recurrent NSTE-ACS. Subsequently multimodality intravascular imaging assessment was performed for the ISR lesion. Optical frequency domain imaging showed the eccentric protruding mass with irregular surface with high-backscatter, whereas angioscopy revealed the in-stent bump with yellow color. The ISR lesion was successfully treated by drug-coated balloon angioplasty. However, he suffered recurrent NSTE-ACS five months later. CAG revealed de novo stenotic lesions not only in re-restenosis of LCx but also in proximal left anterior descending artery and ostium of right coronary artery. He was scheduled to undergo coronary artery bypass grafting for three-vessel disease. Multimodality...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research