Author + information
- Teppei Noda1
Patient initials or identifier number
Relevant clinical history and physical exam
A 33-year-old man with Takayasu's arteritis admitted to our hospital because of worsening chest oppression at rest. He was diagnosed with aortitis at age of 20. At age 25, ACS had developed and CAG revealed severe stenosis in LMT. He underwent PCI with BMS because he refused CABG. For eight years, he had been free from angina. However, 9-month before this admission, in-stent restenosis in LMT was revealed. The second PCI with DCB had been performed. Physical exam was unremarkable.
Relevant test results prior to catheterization
ECG showed ST depression in I, aVL, V3-V6.
Echocardiography showed no localized dysfunction of left ventricular.
The blood test showed no elevation of myocardial necrosis marker and CRP and ESR are normal.
Relevant catheterization findings
CAG showed severe stenosis of ostial LMT deployed with BMS (4.0 × 12 mm Multilink Vision) and no stenosis in RCA.
Collaterals from RCA to LCA was revealed.
PCI was performed via a right femoral artery. LCA was engaged with a 7Fr Hyperion JL 5.0 catheter but it was difficult because the previous stent protruded into an aorta. Sion wire with support catheter could not pass the lesion, but Sion black wire was advanced to distal LAD. The 2.0-15 mm balloon was inflated in LM stent. IVUS revealed neointimal hyperplasia and it composed of fibrotic tissue. Subsequently, 3.5-15 mm balloon was inflated. The lumen within the previous stent was improved by IVUS and angiogram showed an optimal result.
Very late stent restenosis in-patient with Aortitis was successfully treated by PCI. However, restenosis developed rapidly after DCB despite normal inflammatory markers. Other treatments including CABG and DES implantation may be necessary for the future.