Effectiveness of directional coronary atherectomy in treating recurrent in-stent restenosis: a case report.
Case report
Coronary atherectomy
Directional coronary atherectomy
Drug-coated balloon treatment
Intracoronary imaging
Recurrent in-stent lesion
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Aug 2024
Aug 2024
Historique:
received:
24
07
2023
revised:
18
04
2024
accepted:
03
05
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
23
8
2024
Statut:
epublish
Résumé
In-stent restenosis (ISR) remains a significant clinical problem. It is estimated that 10-20% of patients who develop a first event of ISR will develop recurrent ISR (R-ISR). However, the pathology of R-ISR remains largely unknown, and recommendations for its optimal management are lacking. In this case report, we discuss the effectiveness of directional coronary atherectomy (DCA) as an atherectomy device and the mechanism of R-ISR based on pathological findings obtained from DCA. We report the case of a 62-year-old man with a history of ST-segment elevation myocardial infarction treated with percutaneous coronary intervention (PCI) to the mid left circumflex artery using a bare metal stent. Even after the introduction of adequate secondary prevention therapy for ISR, the patient underwent a total of six PCI sessions over 10 years following primary PCI for R-ISR. Eventually, the decision was made to institute treatment with DCA and a drug-coated balloon. No symptoms of restenosis were observed over the following 4 years. In this case report, we demonstrate the effectiveness of DCA treatment for debulking a wide range of collagen-rich plaques and show that DCA treatment should be considered for the treatment of R-ISR.
Sections du résumé
Background
UNASSIGNED
In-stent restenosis (ISR) remains a significant clinical problem. It is estimated that 10-20% of patients who develop a first event of ISR will develop recurrent ISR (R-ISR). However, the pathology of R-ISR remains largely unknown, and recommendations for its optimal management are lacking. In this case report, we discuss the effectiveness of directional coronary atherectomy (DCA) as an atherectomy device and the mechanism of R-ISR based on pathological findings obtained from DCA.
Case summary
UNASSIGNED
We report the case of a 62-year-old man with a history of ST-segment elevation myocardial infarction treated with percutaneous coronary intervention (PCI) to the mid left circumflex artery using a bare metal stent. Even after the introduction of adequate secondary prevention therapy for ISR, the patient underwent a total of six PCI sessions over 10 years following primary PCI for R-ISR. Eventually, the decision was made to institute treatment with DCA and a drug-coated balloon. No symptoms of restenosis were observed over the following 4 years.
Discussion
UNASSIGNED
In this case report, we demonstrate the effectiveness of DCA treatment for debulking a wide range of collagen-rich plaques and show that DCA treatment should be considered for the treatment of R-ISR.
Identifiants
pubmed: 39176022
doi: 10.1093/ehjcr/ytae233
pii: ytae233
pmc: PMC11339653
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Pagination
ytae233Informations de copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: None declared.