369241

The male patient, 66 yrs, was implanted with three stents in m-dLAD(twice 2003&2010). DCB was performed for ISR in LAD stent in 2014. Recently, he was admitted to the hospital due to ACS one month (November 30, 2020). There were 2 years of type 20 diabetes, 20 years of hypertension, 10 years of hyperlipidemia, 10 years of hyperlipidemia, half a day of drinking and 3 smoking a day, denying family history. No obvious abnormality was found in physical examination.

There is no obvious stenosis in LM, 25-50% stenosis in the proximal part of lad, isr25-50% in the original stent in the middle part of lad, 50-75% isr50-75% in the stent from the middle part of lad to the distal part, 50-75% stenosis in D1 opening, 50-75% diffuse stenosis in dlcx, 50-75% stenosis in OM1, 25-75% stenosis in pRCA, 25% stenosis in mRCA, 25% stenosis in dRCA, 75% stenosis in PDA,.


CAGleft1.mp4
CAGleft2.mp4
CAGleft3.mp4
cagleft4.mp4
CAGleft5.mp4
CAGRCA2.mp4

Send the ebu3.75 guiding tube to the left coronary, and measure the lad FFR 0.78 with Abbott pressure wire x 0.014-175cm pressure guide wire, and send it to dragonfly Optis imaging catheter 2.7f-135cm catheter for lad OCT examination, which indicates diffuse fibrous tissue hyperplasia and neo-plaques in m-dLAD stent. And the two-layer stent does not fit completely. dlad MSA is 1.08mm2, mLAD MSA 2.37mm2； The lesions were fully pre dilated with trek 2.0-20mm and NC trek 2.5-15mm & 3.0-15mm. After DCB 2.5-30mm & 3.0-26mm treatment (all 10ATM), OCT was rechecked, dLAD MSA 2.7mm2 and mLAD MSA 4.24mm2; Retest FFR 0.89.
DCB1.mp4
DCB2.mp4
Fianl2.mp4
Final.mp4

The patient was followed up for more than one year without any symptoms. The causes of LAD ISR in this case are very complex, including fibrous tissue hyperplasia, new atherosclerotic plaque and mechanical factors. It is very successful to guide DCB treatment with OCT and FFR.