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Relevant clinical history and physical exam
A 71 years old man came back to our hospital with effort angina. He had the history of primary PCI by a sirolimus-eluting stent in the LAD ten years before, and re-vascularization by balloon angioplasty with in-stent restenosis (ISR) at one-year after primary PCI. The coronary angiography (CAG) demonstrated re-ISR in the LAD and re-vascularization with drug-coated balloon (DCB) was performed.
Relevant catheterization findings
Despite the disappearance of effort angina, one-year follow-up CAG revealed the recurrence of ISR.
The revascularization with bigger size DCB compared to the previous treatment was performed. The distribution of drug was evaluated by optical coherence tomography (OCT) and intravascular coronary angioscopy. Using the co-registration function of OCT enabled us to evaluate drug distribution in the matched images between OCT and angioscopy. The high intensity dots were found in OCT and the white spots corresponded to the OCT high intensity dots were detected on angioscopy, resulting in the optimal drug distribution after DCB.
Three-month after DCB, the serial observation by OCT and angioscopy showed the disappearance of high intensity dots on OCT and white spots on angioscopy, which indicted that these findings could be related with the drug concentration after DCB.