Very resistant stenosis in stent failure - LIVE Case

A 57-year-old male with a history of multivessel PCI—LAD and LCX stents in 2012 and RCA CTO stent in 2022—presented with normal LV function. He was asymptomatic but had a positive nuclear stress test. Control angiography showed suboptimal left coronary arteries with negative iFR. However, there was a tight, short, non-calcified stenosis in the proximal segment of the long RCA stent.

OCT and IVUS revealed an undersized and underexpanded stent. Initial attempts with a non-compliant balloon were unsuccessful, as were saline and contrast Laser 1.9 treatments. Success was achieved using cutting balloons (3.0 mm and 3.5 mm), followed by two DCBs covering the entire RCA stent. The procedure was guided by OCT with the assistance of an extension catheter.

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Key moments

• 02:07–08:24 – Patient presentation
• 08:55–13:26 – Imaging analysis
• 32:02–49:37 – Laser technique
• 50:00–1:05:30 – Step-by-step technique to succeed with resistant in-stent non-calcified restenosis

Keywords: Resistant instent restenosis, laser, cuttting balloon, OCT, IVUS, DCB