18 Dec 2024
Left main bifurcation instent restenosis - LIVE case
LM instent restenosis treated by IVL, OPN and DCB
Operators:
M. Traina, R. Shantouf
Procedural Analyst:
G. Stankovic
Summary
A 76-year-old male with a history of LM PCI (2-stent strategy), RCA PCI, reduced LV function (25%), diabetes, and CKD presented with worsening angina. Angiography revealed in-stent restenosis at the ostium of the LAD and CX, along with RCA occlusion.
The procedure was performed with axillary Impella support via a femoral approach. Lesion preparation included NC balloon dilation, IVL, and OPN, followed by DCB in the LAD ostium. The PCI was IVUS-guided, and a minimal amount of contrast was used.
LIVE Educational Case from Cleveland Clinic - Abu Dhabi, United Arab Emirates
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Key moments
- 16:56-20:40 - Imaging analysis
- 33:05-36:44 - IVUS run before IVL
- 50:50-58:27 - Lesion preparation step-by-step with NC balloon, IVL and OPN
- 1:08:00-1:13:30 - IVUS run after IVL
Keywords: LM instent restenosis, OPN, IVL, IVUS
Learning Objectives
- To learn how to assess the patient for left main PCI
- To discuss the role of imaging in PCI, especially for left main in-stent restenosis
- To learn the best techniques to use in this patient
