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In-stent restenosis (ISR) of Right Coronary Artery (RCA)

Patient History

  • ISR in the RCA
  • FFR: 0.78
  • Inferior ischemia on Cardiolite®1

Baseline Angiography

Baseline angiography of RCA

Baseline angiography of RCA

Pre-PCI HD IVUS (1)

  • Following baseline HD IVUS guidance, a 1st pre-PCI balloon dilation is performed using 3.5 mm X 6.0 mm cutting balloon at 12 ATM.
  • This is followed by 2nd pre-PCI balloon dilation using 4.0 mm × 12.00 mm NC Emerge™ PTCA Dilation Catheter2 at 28 ATM.
  • HD IVUS measurements of proximal and mid-lesion are taken after 1st and 2nd pre-PCI balloon dilations.
Pre-PCI HD IVUS (1) measurements of proximal lesion after 1st cutting balloon dilation – MLA: 3.54 mm2
Pre-PCI HD IVUS (1) measurements of mid-lesion after 1st cutting balloon dilation – MLA: 4.026 mm2
Pre-PCI HD IVUS (1) measurements of proximal lesion after 2nd NC Emerge™ PTCA Dilation Catheter2 dilation – MLA: 7.18 mm2
Pre-PCI HD IVUS (1) measurements of mid-lesion after 2nd NC Emerge PTCA Dilation Catheter2 dilation – MLA: 5.58 mm2

Pre-PCI Angiography

A laser atherectomy is used followed by 4.0 mm x 12.0 mm NC Emerge™ PTCA Dilation Catheter2.

Pre-PCI angiography after laser atherectomy and NC Emerge™ PTCA Dilation Catheter balloon dilation

Post-PCI Angiography

RCA is stented using 3.5 mm X 28.0 mm Promus PREMIER™ Everolimus-Eluting Platinum Chromium Coronary Stent3. This is followed by post-stent dilation using a 4.0 mm X 12.0 mm NC Emerge™ PTCA Dilation Catheter2.

Post-PCI angiography after post-PCI, post-balloon dilation – View 1
Post-PCI angiography after post-PCI, post-balloon dilation – View 2

Conclusion

HD IVUS reveals the ISR within the RCA, helped with sizing of RCA, revealed the success of balloon dilations, atherectomy, facilitating an optimal PCI result.

Baseline Angiography

Baseline angiography of RCA

Baseline HD IVUS

Baseline HD IVUS of RCA

Baseline HD IVUS

Baseline HD IVUS measurements of proximal RCA lesion – MLA: 2.64 mm2

Baseline HD IVUS

HD IVUS measurements of mid-RCA lesion – MLA: 2.85 mm2

Pre-PCI HD IVUS (1)

Pre-PCI HD IVUS (1) measurements of proximal lesion after 1st cutting balloon dilation – MLA: 3.54 mm2

Pre-PCI HD IVUS (1)

Pre-PCI HD IVUS (1) measurements of mid-lesion after 1st cutting balloon dilation – MLA: 4.026 mm2

Pre-PCI HD IVUS (1)

Pre-PCI HD IVUS (1) measurements of proximal lesion after 2nd NC Emerge™ PTCA Dilation Catheter2 dilation – MLA: 7.18 mm2

Pre-PCI HD IVUS (1)

Pre-PCI HD IVUS (1) measurements of mid-lesion after 2nd NC Emerge PTCA Dilation Catheter2 dilation – MLA: 5.58 mm2

Pre-PCI Angiography

Pre-PCI angiography after laser atherectomy and NC Emerge™ PTCA Dilation Catheter balloon dilation

Pre-PCI HD IVUS (2)

Pre-PCI HD IVUS (2) measurements of proximal lesion after laser atherectomy and NC Emerge™ PTCA Dilation Catheter dilation – MLA: 7.71 mm2

Pre-PCI HD IVUS (2)

Pre-PCI HD IVUS (2) measurements of mid-lesion after laser atherectomy and NC Emerge™ PTCA Dilation Catheter dilation –MLA: 5.41 mm2

Post-PCI Angiography

Post-PCI angiography after post-PCI, post-balloon dilation – View 1

Post-PCI Angiography

Post-PCI angiography after post-PCI, post-balloon dilation – View 2

Post-PCI HD IVUS

Post-PCI HD IVUS

Post-PCI HD IVUS

Post-PCI HD IVUS measurements of proximal lesion - MLA: 10.15 mm2

Post-PCI HD IVUS

Post-PCI HD IVUS measurements of mid-lesion - MLA: 6.27 mm2

References
  1. Cardiolite® is a trademark of Lantheus Medical Imaging
  2. NC Emerge is a trademark of Boston Scientific Corp.
  3. Promus PREMIER™ is a trademark of Boston Scientific Corp.