Strategies in Bifurcation In-Stent Restenosis (ISR)-Dr. Almerri case presentation

Video Transcription

Video Summary

The transcript details a medical case presentation involving a 58-year-old patient with angina and a history of diabetes, smoking, and previous coronary interventions. Initially, the patient underwent PCI using the DK crush technique with stenting in the LAD and diagonal branch, and years later, in the circumflex artery. Recently, the patient experienced angina again, showing issues at the obtuse marginal branch's ostium due to neoatherosclerosis and under-expanded stents. Specialists discussed treatment, emphasizing vessel preparation with high-pressure balloons and drug-coated balloons for plaque modification, rather than additional stenting. They highlighted the importance of imaging for understanding restenosis mechanisms and advised against using cutting balloons aggressively or relying solely on stenting. The patient’s condition improved post-treatment, with successful vessel expansion and healing. The discussion underscores the necessity of strategic intervention to prevent further stent layering in bifurcation procedures, aligning with best practices in interventional cardiology.

Keywords

neoatherosclerosis

DK crush technique

drug-coated balloons

restenosis mechanisms

interventional cardiology