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Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanDepartment of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Corresponding author: Dr Fumiyuki Otsuka, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1, Kishibe-shimmachi, Suita, Osaka, 564-8565 Japan. Tel.: +81 (6) 6170-1070; fax: +81 (6) 6170-1782.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanDepartment of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, JapanDepartment of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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).
Figure 1Multimodality imaging assessment in recurrent in-stent restenosis attributable to
calcified nodule (white and yellowasterisks). 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.
