Case 89: PCI Manual - Peripheral DCB for coronary ISR

A patient presented with recurrent LAD in-stent restenosis, despite multiple procedures with balloon angioplasty and brachytherapy. IVUS demonstrated neotinima formation with good expansion of the restenosed stents. Given failure to prevent restenosis with brachytherapy and balloon angioplasty, a 4.0x40 mm IN.PACT Admiral balloon was delivered with difficulty and inflated in the mid LAD lesion over a Mailman 300 cm guidewire.
In cases of recurrent coronary in-stent restenosis refractory to other treatments, such as brachytherapy, a peripheral drug-coated balloon could be used off-lable, but delivery can be challenging due to the high profile of the device.

[@mohamedadam9391]

What is the indication of long wire

[@praveenalane4331]

Thanx for case ...What is your opinion on using cutting balloon for predilatation for ISR ??

[@guozhuchen5511]

Good question! I often use cutting balloon for lesion preparation and Isr to avoid stent underexpansion. And we use DCB for isr as first choice if patients have enough money.

[@praveenalane4331]

What is your method of deploying Second DES in case of focal ISR ..? Would deploy the lesion site or a longer stent extending beyond the entire length of stent ( from healthy to healthy) ?