인문학
사회과학
자연과학
공학
의약학
농수해양학
예술체육학
복합학
DBpia AI
AI 에이전트
AI 아이디어
AI 리더
AI 뷰어
Citeasy
크롬 서지관리 다운로드
지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록·키워드
Case PresentationWe report the case of a 77-year-old man admitted with unstable angina.His medical history was notable for prior percutaneous coronary intervention (PCI) to the left anterior descending artery (LAD) in 2017, with implantation of two overlapping stents (2.5 15 mm and 2.75 18 mm), and diffuse large B-cell non-Hodgkin lymphoma treated within the previous 12 months.Coronary angiography revealed a significant in-stent restenosis (ISR) of the proximal LAD (Fig. 1A,B), a 40% stenosis of the left circumflex artery (LCx), and a long, visually estimated 50%-70% stenosis of the mid right coronary artery (RCA) (Fig. 2A,B).Given the complexity of the LAD ISR, we elected to initially address this lesion using an IVUS-guided approach, with the aim of identifying the dominant restenosis mechanism and tailoring the interventional strategy accordingly.Intravascular imaging of the proximal LAD ISR demonstrated stent underexpansion with a minimum stent area (MSA) of 3.8 mm proximally and 3.1 mm distally ((Fig. 1 D,E), with only focal malapposition in selected frames (Fig. 1C).Because the stent covered the LAD ostium, a proximal non-stented reference segment was not available; therefore, vessel sizing was derived from the first non-stented distal reference segment immediately distal to the stent (beyond the first septal branch), which showed a reference lumen area of 5.8 mm (Dmax 3.1 mm; Dmin 2.3 mm) (Fig. 1F).Relative stent expansion, defined as MSA divided by the distal reference lumen area, was 65.5% (proximal MSA) and 53.4% (distal MSA), consistent with marked underexpansion and a clear mismatch between the previously implanted stent dimensions and the distal reference vessel size.The entire IVUS pullback run is provided as a supplementary video.The LAD ISR was treated with high-pressure dilatation using a 3.5-mm non-compliant (NC) balloon, followed by a 3.5-mm cutting balloon (CB) and subsequent inflation of a 3.5-mm paclitaxel-coated drug-coated balloon (P-DCB), achieving an angiographically satisfactory result (Figure 1E,F).To assess the haemodynamic significance of the RCA lesion, functional coronary angiography (FCA) using CAAS-vFFR (Pie Medical Imaging BV, Maastricht, the Netherlands) was chosen as a rapid, wire-free physiological assessment during the index procedure.Three-dimensional QCA demonstrated a lesion length of 34.5 mm, with a diameter stenosis of 49% and an area stenosis of 74%.The resulting vFFR was 0.70, well below the 0.80 cut-off and outside the grey zone, with 3D analysis showing a predominantly focal pressure-drop pattern (Figure 2C).Lesion preparation consisted of predilatation with a 3.0 20-mm semi-compliant balloon followed by a 3.0 20-mm non-compliant balloon (Figure 2D), resulting in an adequate angiographic outcome (Figure 2E).Given the patient's high bleeding risk, a stent-free strategy was selected, consisting of prolonged inflation of a paclitaxel-coated drug-coated balloon sized 1:1 to the reference vessel diameter (Figure 2F).DCB inflation resulted in a 10-15-mm linear National Heart, Lung, and Blood Institute (NHLBI) type B dissection, without flow limitation (Figure 2G,H).
인공지능 문자 인식 모델을 통해 추출된 텍스트로, 일부 오타나 오류가 포함될 수 있으나 지속적으로 개선 중입니다.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
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