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Canadian Journal of Cardiology

Temporal Changes in Near-Infrared Spectroscopy Signals in Recurrent In-Stent Restenosis Attributable to Calcified Nodule

      A 75-year-old man with angina on hemodialysis underwent rotational atherectomy and drug-eluting stent (DES) placement (Resolute Onyx; Medtronic, Minneapolis, Minnesota) in his heavily calcified right coronary artery. Eleven months later, he showed severe in-stent restenosis (ISR) (1st ISR). Intravascular ultrasound (IVUS) exhibited heavily calcified neointima, and an additional DES (Synergy; Boston Scientific, Marlborough, Massachusetts) was implanted (Fig. 1A ). He suffered a 2nd ISR only 1 month later, and optical coherence tomography (OCT) showed protruding neointima with remarkable attenuation (yellow asterisks in Fig. 1B) that obscured the underlying stent struts, suggestive of in-stent calcified nodule, which was successfully treated with drug-coated balloon (DCB) (SeQuent Please; Braun, Melsungen, Germany) (Fig. 1B).
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      Figure 1Multimodality imaging assessment in recurrent in-stent restenosis attributable to calcified nodule (white and yellow asterisks). During the process of recurrent ISR and repeated revascularisation, a gradual decrease in NIRS signals was observed, which eventually disappeared (white arrow heads). White arrows correspond to cross-sectional intravascular images. White lines in (A) correspond to the stent implanted sites. White broken lines in (C-E) correspond to longitudinal NIRS-IVUS images. DCB, drug-coated balloon; DES, drug-eluting stent; ELCA, excimer laser coronary angioplasty; ISR, in-stent restenosis; IVUS, intravascular ultrasound; maxLCBI4mm, maximum lipid-core burden index at any 4-mm segment; NIRS, near-infrared spectroscopy; PCI, percutaneous coronary intervention; POBA, plain old balloon angioplasty.
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