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Right coronary instent occlusion (due to interruption of anti-platelet therapy).

Clinical background

4th restenosis in the right coronary artery, highly symptomatic patient. 


The history of the patient in three years was a first treatment of an accute coronary stenosis on the right side treated by drug eluting stent, followed the second time by a restenosis in the DES with a more proximal restenosis and treated again with an over stent but he had a third restenosis treated by a drug eluting balloon. Today he faces a complete restenosis in the RCA.


  • double access : femoral for right coronary artery and radial for left coronary artery 
  • guidewire escalation to cross the proximal RCA
  • enlargment of the channel by ELCA (Excimer Laser) fiber 0.9 mm (spectraclitics)
  • post-diltatation after stent
  • placement of DES polymer free distally
  • placement of DES proximally
  • treatment of proximal restenosis by drug eluting balloon inflation

Learning points

  • Managment of complex instent restenosis (third episode)
  • Guidewire escalation for CTO
  • Selection of stents
  • Use of laser angioplasty to enlarge the channel and cope with complex lumen
  • Use of drug eluting balloon to prevent restenosis in instent restenosis
Shooting date : 2016-03-22
Last update : 2021-06-09
Max Amor
Essey-lès-Nancy, France
Michaël Angioi
Essey-Lès-Nancy, France

Coroflex® ISAR / B. Braun

Sirolimus eluting polymer-free coronary stent system

SeQuent® Please NEO / B. Braun

Next generation coronary Drug Coated Balloon to treat vascular stenosis
1 comment
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  • Ghulam Rasool M. Excellent case done very nicely

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