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Published on: May 14, 2013
Refractory In-Stent Restenosis Attributable to Eruptive Calcified Nodule
Hiroki Nakano1,2, Yu Kataoka1, Fumiyuki Otsuka1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
This study presents a novel approach for managing recurrent in-stent restenosis (ISR) caused by calcified nodules, utilizing excimer laser catheter ablation to prevent further occurrences in a hemodialysis patient.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nephrology
Background:
- Recurrent in-stent restenosis (ISR) poses a significant challenge in interventional cardiology, particularly in patients with comorbidities like those on hemodialysis.
- Neointimal hyperplasia is a common cause of ISR, but calcified nodules can also impede coronary blood flow post-intervention.
Abstract:
A 75-year-old female patient on hemodialysis presented with non-ST-segment elevation myocardial infarction. After successful primary percutaneous coronary intervention, in-stent restenosis (ISR) occurred 3 consecutive times. Intravascular imaging assessment during the repeated percutaneous coronary intervention indicated that the ISR was not associated with neointimal hyperplasia but was mainly attributed to a calcified nodule, which protruded into the lumen. We applied excimer laser catheter ablation to avoid another ISR. (Level of Difficulty: Intermediate.).
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