Minimally invasive atherectomy with a virtual 3-Fr sheathless guiding catheter and a 0.9-mm excimer laser catheter for t
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CASE REPORT
Minimally invasive atherectomy with a virtual 3-Fr sheathless guiding catheter and a 0.9-mm excimer laser catheter for the treatment of coronary in-stent restenosis: a case report Sho Hashimoto1 • Akihiko Takahashi1 • Yukio Mizuguchi1 • Takeshi Yamada1 Norimasa Taniguchi1 • Tetsuya Hata1
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Received: 22 June 2015 / Accepted: 11 September 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 50-year-old man underwent percutaneous coronary intervention for stent restenosis in his left anterior descending artery. After insertion of a 5-Fr sheathless guiding catheter through the right radial artery, optical coherence tomography (OCT) revealed a circumferential dense fibrotic plaque in the distal part of the stent. Therefore, we performed excimer laser coronary atherectomy using a 0.9-mm concentric catheter and dilatation with a drug-coated balloon catheter. Subsequent OCT revealed a circumferential reduction of the neointimal material. The patient’s clinical course was uneventful, and he was discharged 2 days after the percutaneous coronary intervention without any access site complications.
ELCA catheter has recently become available in Japan in July 2014. Although the indication for ELCA is considered limited [2, 3], the 0.9-mm ELCA catheter may facilitate the treatment of coronary lesions that are difficult to treat via conventional balloon angioplasty. In addition, this 0.9-mm catheter may be able to pass through a 5-Fr guiding catheter (internal diameter 1.50–1.51 mm), although no reports have described the feasibility of treatment with a 5-Fr guiding catheter or whether a sufficient saline flush can be delivered during the operation. In this report, we describe the successful treatment of stent restenosis using a 0.9-mm ELCA catheter and a sheathless 5-Fr guiding system [4].
Keywords Excimer laser coronary atherectomy Slender PCI In-stent restenosis
Case report Introduction Miniaturization of devices for percutaneous coronary intervention (PCI) has facilitated the development of less invasive procedures that reduce the incidence of access site complications and contribute to early patient ambulation. These miniaturized devices include guiding catheters, balloon catheters, stent delivery systems, and diagnostic devices [1]. Similarly, excimer laser coronary atherectomy (ELCA) catheters have been miniaturized, and a 0.9-mm
& Akihiko Takahashi [email protected] 1
Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Sumaku, Kobe, Hyogo 654-0026, Japan
A 50-year-old man underwent primary PCI with a bare metal stent (Kaname 3.5/24 mm; Terumo, Japan) in the proximal part of the left anterior descending artery (LAD) for acute myocardial infarction. Two months later, a second PCI was performed using a drug-eluting stent (Resolute 3.5/15 mm, Medtronic, Minneapolis, MN) for residual stenosis in the distal LAD. Eleven months later, a followup angiogram revealed restenosis in the Kaname stent (Fig. 1) and a decreased fractional flow res
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