In-stent Restenosis of Left Main Chimney Stent with Successful Percutaneous Coronary Intervention with Drug-Coating Balloon: A case report and literature reviews

Figures

• 

  Late ISR in a chimney stent in neosinus with successful treatment by CB and DCB. LM, left main; TAVR, transcatheter aortic valve replacement; ISR, in-stent restenosis.

• 

  Figure 1. Pre-procedural planning with multi-slice computed tomography demonstrating considerable risk of left coronary artery obstruction with low coronary ostium height, 11.0 mm of left coronary artery (A). Calcified left coronary leaflet and leaflet length 17.6 mm (B) and shallow sinuses of Valsalva with diameter 26.2 mm at left cuspid (C). Sinotubular junction 22.3 mm in average diameter (D).

• 

  Figure 2. Coronary ostium obstruction in transcatheter aortic valve replacement. Patent ostial left main before transcatheter heart valve deployment (A). Pre-positional stent at left main before transcatheter heart valve deployment (B). Ostial left main partial obstruction by native valve after transcatheter heart valve placement (C). Increasing ostial left main diameter after chimney stent deployment and post-dilatation (D and E).

• 

  Figure 3. Intravascular ultrasound of chimney stent in-stent restenosis. Patent stent inside of left main and ostium (A). Neointima formation at chimney stent out of left main with contralateral compressive deformity by transcatheter heart valve stent (B and C). No stenosis at the ostium of chimney stent (D).

• 

  Figure 4. In-stent restenosis percutaneous coronary intervention to the left main chimney stent. In-stent restenosis of chimney stent inside neosinus (A). Post POBA, including cutting balloon dilatation and drug-coating balloon over chimney stent at the left main (B). Regain the potency of chimney stent in left main in final angiogram (C). The intravascular ultrasound image of stenosis of chimney stent post CB and DCB dilatation (D and E) with image (D) position correlating to Figure 3B and image (E) to Figure 3C.