Refractory In-Stent Restenosis Attributable to Eruptive Calcified Nodule

Hiroki Nakano; Yu Kataoka; Fumiyuki Otsuka; Takahiro Nakashima; Yasuhide Asaumi; Teruo Noguchi; Satoshi Yasuda

doi:10.1016/j.jaccas.2020.06.035

Refractory In-Stent Restenosis Attributable to Eruptive Calcified Nodule

JACC Case Rep. 2020 Sep 2;2(12):1872-1878. doi: 10.1016/j.jaccas.2020.06.035. eCollection 2020 Oct.

Authors

Hiroki Nakano^{1

2}, Yu Kataoka¹, Fumiyuki Otsuka¹, Takahiro Nakashima¹, Yasuhide Asaumi¹, Teruo Noguchi¹, Satoshi Yasuda¹

Affiliations

¹ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
² Department of Cardiology, Tokyo Medical University, Tokyo, Japan.

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.).

Keywords: ACS, acute coronary syndrome; CN, calcified nodule; DAPT, dual-antiplatelet therapy; DES, drug-eluting stent; ELCA, excimer laser catheter ablation; ISR, in-stent restenosis; IVUS, intravascular ultrasound; OCT, optical coherence tomography; PCI, percutaneous coronary intervention; RCA, right coronary artery; calcified nodule; in-stent restenosis; intravascular imaging; percutaneous coronary intervention.

Publication types

Case Reports