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