Challenging treatment of in-stent restenosis in a coronary bifurcation by implantation of a bioresorbable scaffold under optical coherence tomography guidance

摘要

A 67-year-old male patient with stable angina, hypertension and hypercholesterolemia who underwent bare metal stent (BMS) implantation in the distal right coronary artery (RCA) (Azule 3 × 9 mm) and everolimus-eluting stent (EES) implantation in the first diagonal branch (D1) (Xience 2.25 × 18 mm) and in the proximal circumflex branch (LCx) (Xience 3 × 28 mm). One year subsequent to the precedure the patient was readmitted for relapse of the angina Canadian Cardiovascular Society scale II, exhibiting a positive exercise test. The coronary angiography showed a distal-edge in-stent restenosis (ISR) in the distal RCA, extending to the posterior descending artery (PDA), Medina 110 bifurcation (Fig. 1A). Optical coherence tomography (OCT) showed predominantly fibrolipidic restenotic tissue, with minimal lumen area (MLA) 1.95 mm2, minimal lumen diameter (MLD) 1.57 mm, proximal reference vessel diameter (RVD) 3.1 mm, distal RVD 2.75 mm and lesion length 21.2 mm (Fig. 1B, C).