PMC8086676_01
A, D. The coronary angiography shows a distal-edge in-stent restenosis in the distal right coronary artery, extending to the PDA, Medina 110 bifurcation; B, C. Optical coherence tomography (OCT) shows predominantly fibrolipidic restenotic tissue; D. An optimal angiographic result after proximal-optimalization-technique with a non-compliant-balloon 3.25 x 15 mm (16 atm) performed by placing the proximal edge of the distal marker of the balloon at the carina of the PDA-PLA bifurcation; E, F. Optimal apposition, expansion and structural integrity of the device and clear access to the PLA side branch through the scaffold struts as assessed by OCT; PDA : posterior descending artery; PLA : posterolateral artery.
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The coronary angiography showed a distal-edge in-stent restenosis (ISR) in the distal RCA, extending to the posterior descending artery (PDA), Medina 110 bifurcation (Fig. 1A). Optical coherence tomography (OCT) showed predominantly fibrolipidic restenotic tissue, with minimal lumen area (MLA) 1.95 mm2, minimal lumen diameter (MLD) 1.57 mm, proximal reference vessel diameter (RVD) 3.1 mm, distal RVD 2.75 mm and lesion length 21.2 mm (Fig. 1B, C). Proximaloptimalization-technique with an NC-balloon 3.25 x 15 mm (16 atm) was then performed by placing the proximal edge of the distal marker of the balloon at the carina of the PDA-PLA bifurcation, with an optimal angiographic result (Fig. 1D). A final OCT pullback showed optimal apposition and expansion (MLA 5.3 mm2/MLD 2.6 mm; Fig. 1E), structural integrity of the device and clear access to the PLA side branch through the scaffold struts (Fig. 1F).