PMC5996433_01
First time coronary angiography and corresponding OCT image. (a) Angiography demonstrated tandem stenotic lesions within the previously implanted stent. (b) OCT revealed severely calcified neointima (asterisks) within well-expanded stent struts (arrowheads) at the distal stenotic site. OCT: optical coherence tomography.
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fig1
Coronary angiography determined the tandem stenotic lesions within the previously implanted PES as shown in Figure 1(a). Optical coherence tomography (OCT) revealed excessive neointimal hyperplasia within well-expanded stent struts at the distal site (Figure 1(b)).
Coronary angiography and corresponding OCT image after PCB and DES implantation. (a) Angiography showed residual stenosis at the newly stented site. (b) OCT image of the lesion treated with PCB. (c) Ununiformed dilatation of newly implanted DES and dilation failure of calcified neointima. (d) Postdilatation with noncompliant balloon. White arrow: balloon indentation. OCT: optical coherence tomography, PCB: paclitaxel-coated balloon, DES: drug-eluting stent.
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fig2
AG, Vascular System, Berlin, Germany) was utilized for the proximal lesion, and a 2.25 x 18 mm everolimus-eluting stent (Xience Xpedition; Abbott Vascular, Santa Clara, California) was implanted at the distal lesion. Although the proximal lesion was well treated with PCB, the coronary angiography still demonstrated moderate stenosis at the distal lesion (Figures 2(a) and 2(b)). OCT revealed underexpansion of the newly implanted stent because an attempt at balloon dilatation of neointimal calcification failed (Figure 2(c)). Furthermore, a bigger size noncompliant balloon of 2.75 mm at high inflation pressure (24 atm) did not work well (Figure 2(d)).