Select Page
  1. Home
  2. IVUSAID Cases
  3. Case 18: In-stent restenosis treated with RA and lithotripsy

Case 18: In-stent restenosis treated with RA and lithotripsy

Case Presentation

A 58-year-old male presented with CCS class III chest pain to our hospital. He had a history of hypertension, diabetes mellitus, hyperlipidemia, and multiple PCIs. Most recently, a year ago, DESs were implanted in the proximal LAD (4.5 x 20mm) and mid LAD (4.0 x 48mm). Coronary angiography showed 80% in-stent restenosis in the proximal and mid LAD. Further assessment with IVUS showed concentric and eccentric neointimal hyperplasia, stent underexpansion and two stent layers in the proximal LAD. The MLA of the lesion was 2.9mm².

IVUS pre-treatment

Based on IVUS findings, we performed lesion modification with 1.75mm rotational atherectomy (RA) and then dilated with 4.5mm non-compliant (NC) balloon in the proximal LAD and 3.25mm NC balloon in the mid LAD. After ballooning, repeat IVUS showed significant increase in lumen area in the proximal and mid LAD with post procedural MLA 6.2mm².

IVUS post-treatment

In this case, IVUS helped classify mechanism of ISR (neointimal hyperplasia and stent underexpansion in the presence of two stent layers) and determine the optimal treatment strategy. Based on imaging, the lesion was treated with RA and NC balloon, and additional vascular brachytherapy (VBT) treatment was planned.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

Left Main DK Crush Video ID