Multi instrumental complex instent right coronary occlusion : Laser angioplasty Polymer free stent, drug eluting balloon

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.

Description

• 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