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CASE20191114_002
| IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Imaging: Intravascular | |
| Common but Less Recognized Mechanism of In-Scaffold Re-Stenosis | |
| Jiunn-Cherng Lin1, Hsin-I Teng1 | |
| Taichung Veterans General Hospital, Taiwan1, | |
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[Clinical Information]
- Patient initials or identifier number:
D10130
-Relevant clinical history and physical exam:
A case of 67-year-old man who has paroxysmal atrial fibrillation underwent transcatheter ablation of pulmonary vein isolation.He has one episode of old NSTE-ACS, underwent PTCA with one BVS over LAD-M, with optimal resultHowever, he got occult chest tightness during exercise after 1.5 years.
 01 pre-BVS (2016-2).mp4 02 post-BVS (2016-2).mp4-Relevant test results prior to catheterization:
Treadmill exercise test: positive.
- Relevant catheterization findings:
F/U CAG showed proximal segment of BVS: in-scaffold re-stenosis.
03 BVS ISR (2017-6).mp4 04 IVUS.mp4 05 OCT calcium nodule.mp4 |
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[Interventional Management]
- Procedural step:
Guiding catheter: XB 3.5/6 guide. Guide wire: Whisper Extrasupport. Pre-dilatation: Trek balloon (3.0x15mm) with 12 atm pressure. Stenting: Xience Expedition (3.5x28mm) over-lapping with BVS proximal re-stenotic segment. Post-dilatation: NC Trek balloon (3.5x15mm) with 22 atm inflation pressure & NC Trek balloon (4.0x8mm) with 18 atm pressure. << Follow Up>> Follow Angio 2 years later: patent. Follow FFR 2 years later: Pd/Pa 0.89. Follow RFR 2 years later: 0.90. Follow OCT 2 years later: mild intima hyperplasia. No MACE in this 2-year period. 06 Final CAG.mp4 06 Final IVUS.mp4 06 OCT final.mp4- Case Summary:
Calcium nodule is one of the etiology of in-stent/in-scaffold re-stenosis (ISR).Image study is essential for BRS implantation, especially in calcified lesion.Even more than 3 years, BVS may not be resorbed completely.Calcium nodule related ISR could be safely rescued by further DES implantation. BVS overlapping with DES is acceptable.
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