Bağcılar Education and Research Hospital
A 58-year-old male patient who had previously undergone bypass surgery is scheduled for dominant LCX PCI procedure (Video 1). According to the size of the lesion, 4.0 × 32 mm BMS is placed after the pre-dilation with a small balloon (Video 2). Stent underexpansion is clear ( Figure 1). Post-dilatation with 4.0 short NC balloon ( Figure 2). He is discharged with residual stenosis (Video 3).
The patient is scheduled to undergo direct coronary angiography three months after the first procedure when his complaints resume and are more severe than before. LM-LCX stent has severe ISR and severe LAD osteal stenosis that supply D1 (Video 4). Crossing the lesion with a floppy wire through 6 Fr AL-2 guiding catheter and predilatation with a small balloon ( Figure 3). Then a 4.0 × 23 mm NC balloon is delivered (Video 5). Stent expansion is still insufficient after NC balloon dilatation ( Figure 4). When the NC balloon bursts at 35 atm in a forth attempt and distal stent overexpansion occurs, a new 4.0 × 15 mm short NC balloon is delivered ( Figure 5). Due to the previously restricted LAD flow severe angina developed and the LAD was wired (Video 6). In order to avoid destroying stent struts, the LAD flow was restorated with a 1.25 × 9 mm balloon (Video 7). After the dilation of the second NC balloon with 35 atm 4 times and the better stent expansion was achieved ( Figure 5). Then a 3.5 × 20 mm drug balloon was delivered to the restenosis zone (Video 8). The result is acceptable and the process has been terminated because all available possibilities have been used (Video 9).