In-stent restenosis (ISR) of Right Coronary Artery (RCA)
Patient History
- ISR in the RCA
- FFR: 0.78
- Inferior ischemia on Cardiolite®1
Baseline angiography of RCA Baseline HD IVUS
Baseline HD IVUS of proximal and mid-RCA lesions
Baseline HD IVUS of RCA Baseline HD IVUS
Baseline HD IVUS measurements of proximal RCA lesion – MLA: 2.64 mm2
Baseline HD IVUS
HD IVUS measurements of mid-RCA lesion – MLA: 2.85 mm2
Pre-PCI HD IVUS (1)
- Following baseline HD IVUS guidance, a 1st pre-PCI balloon dilation is performed using 3.5 mm X 6.0 mm cutting balloon at 12 ATM.
- This is followed by 2nd pre-PCI balloon dilation using 4.0 mm × 12.00 mm NC Emerge™ PTCA Dilation Catheter2 at 28 ATM.
- HD IVUS measurements of proximal and mid-lesion are taken after 1st and 2nd pre-PCI balloon dilations.
Pre-PCI HD IVUS (1)
Pre-PCI HD IVUS (1) measurements of proximal lesion after 1st cutting balloon dilation – MLA: 3.54 mm2
Pre-PCI HD IVUS (1)
Pre-PCI HD IVUS (1) measurements of mid-lesion after 1st cutting balloon dilation – MLA: 4.026 mm2
Pre-PCI HD IVUS (1)
Pre-PCI HD IVUS (1) measurements of proximal lesion after 2nd NC Emerge™ PTCA Dilation Catheter2 dilation – MLA: 7.18 mm2
Pre-PCI HD IVUS (1)
Pre-PCI HD IVUS (1) measurements of mid-lesion after 2nd NC Emerge™ PTCA Dilation Catheter2 dilation – MLA: 5.58 mm2
Pre-PCI Angiography
A laser atherectomy is used followed by 4.0 mm x 12.0 mm NC Emerge™ PTCA Dilation Catheter2.
Pre-PCI angiography after laser atherectomy and NC Emerge™ PTCA Dilation Catheter balloon dilation Pre-PCI HD IVUS (2)
HD IVUS after laser atherectomy and 4.0 mm x 12.0 mm NC Emerge™ PTCA Dilation Catheter2 dilation.
Pre-PCI HD IVUS (2)
Pre-PCI HD IVUS (2) measurements of proximal lesion after laser atherectomy and NC Emerge™ PTCA Dilation Catheter dilation – MLA: 7.71 mm2
Pre-PCI HD IVUS (2)
Pre-PCI HD IVUS (2) measurements of mid-lesion after laser atherectomy and NC Emerge™ PTCA Dilation Catheter dilation –MLA: 5.41 mm2
Post-PCI Angiography
Post-PCI angiography after post-PCI, post-balloon dilation – View 1 
Post-PCI angiography after post-PCI, post-balloon dilation – View 2 Post-PCI HD IVUS
Post-PCI HD IVUS
Post-PCI HD IVUS Post-PCI HD IVUS
Post-PCI HD IVUS measurements of proximal lesion - MLA: 10.15 mm2
Post-PCI HD IVUS
Post-PCI HD IVUS measurements of mid-lesion - MLA: 6.27 mm2
Conclusion
HD IVUS reveals the ISR within the RCA, helped with sizing of RCA, revealed the success of balloon dilations, atherectomy, facilitating an optimal PCI result.
References
- Cardiolite® is a trademark of Lantheus Medical Imaging
- NC Emerge™ is a trademark of Boston Scientific Corp.
- Promus PREMIER™ is a trademark of Boston Scientific Corp.
