How to treat recurrent lmca instent restenosis
European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain
AWARD CASE SESSION – VOTING
How to treat recurrent lmca instent restenosis
Author: Jo Dens, MD, PhD and Daan Cottens, MD, hospital Oost-Limburg Genk, Belgium
CASE PRESENTATION
- Male, 71 years old
- Presenting symptom: – Stable angina CCS 2-3
- Cardiovascular risk factors: – Ex-smoker, DM +, AHT +, dyslipidemia +
- Medication: – Acetylsalicylic acid 80mg 1dd, clopidogrel 75mg 1dd, atorvastatin 10mg 1dd, lisinopril 20mg 1dd, bisoprolol 5mg 1dd, metformin 850mg 3dd, gliclazide 60mg 1dd, allopurinol 300mg 1dd, sublingual nitrates as needed
- Medical history:
- 1991: Myocardial infarction R/ CABG LIMA>L1cx ; RIMA>distal RCA
- 4/2017: Stable angina (medina 1-1-1 severe distal LMCA bifurcation stenosis) + D1
- 4/2017: PCI culo[e LMCA (TRYTON) + PCI D1
- 12/2018: Stable angina CCS 2: in-stent restenosis LMCA
- 12/2018: PCI LMCA – OCT guided stent optimization + drug eluting balloon
SUMMARY
- In-stent re-restenosis remains a challenging issue
- Recurrence rate is high (> 5%->20%)
- OCT guided revascularization is preferred
- Different options…
- High pressure balloons/cutting balloons
- Intravascular lithotripsy
- Laser
- In-stent rota…
- CABG