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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

Baseline HD IVUS

Baseline HD IVUS of proximal and mid-RCA lesions

Baseline HD IVUS of RCA
Baseline HD IVUS measurements of proximal RCA lesion – MLA: 2.64 mm2
HD IVUS measurements of mid-RCA lesion – MLA: 2.85 mm2

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

Pre-PCI HD IVUS (2)

HD IVUS after laser atherectomy and 4.0 mm x 12.0 mm NC Emerge™ PTCA Dilation Catheter2 dilation.

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) measurements of mid-lesion after laser atherectomy and NC Emerge™ PTCA Dilation Catheter dilation –MLA: 5.41 mm2

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

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 measurements of mid-lesion - MLA: 6.27 mm2

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.

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.
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