ABSTRACT
This case illustrates an example of diffuse and unexpected failure following implantation of drug-eluting stents (slides 1-6 ( frames 1-15 and run 1)). The baseline frame ( frame 1) illustrates the index procedure, while frame 2 illustrates the result following extensive reconstruction of the bifurcation of the circumflex and obtuse marginal branch utilizing Cypher stents (Cordis) and the crush technique. The follow-up result at 10 months surprisingly shows a sustained patency on the bifurcation with some narrowing, but multiple restenosis involving the distal circumflex and the distal portion of the obtuse marginal branch with a total occlusion of the most distal Cypher stent ( frame 4). The procedure was repeated utilizing aggressive pre-dilatation with short cutting balloons as illustrated in frames 5 and 6. Following this pre-dilatation, we re-established good forward flow as shown in frame 7. The in-stent restenosis was then treated with a Taxus stent (Boston Scientific) utilizing a unique approach of crush over previous crush. This is demonstrated in frames 8 and 9, with the result shown in frame 10. In this case, final kissing balloon was utilized. Owing to the presence of residual narrowing in the distal part of the obtuse marginal branch, a small Taxus stent had to be advanced through the bifurcation distally. This is effectively demonstrated in run 1.
