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How to treat recurrent lmca instent restenosis

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

 

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