Abstract
The case was a 50-years old man with insulin-treated type 2 diabetes mellitus. Bare metal stent (BMS) implantation for segment 6 (#6) was performed due to acute myocardial infarction (AMI) in 2004. Eight months follow-up coronary angiography (CAG) revealed no in-stent restenosis (ISR). He had inferior AMI in 2009. CAG revealed total occlusion at #3 and 90% stenosis at #14, and BMS implantation for #3 was performed. Staged drug-eluting stent (DES) implantation for #14 was performed. One year follow-up CAG revealed no ISR at #3 and #14, but revealed new lesions at #1, 6, 11. Fractional flow reserve (FFR) revealed functional double vessel disease (right coronary artery (RCA); 0.68, left anterior descending artery (LAD); 0.74, left circumflex artery (LCX); 0.85). Therefore, DES implantaion for #6 and BMS implantaion for #1 were performed. One year follow-up CAG revealed no ISR at #1, but revealed ISR at #7 and the progression of stenosis at #4 postero descending and #11. Because FFR revealed functional triple vessel disease (RCA; 0.72, LAD; 0.73, LCX; 0.74), coronary artery bypass graft (CABG) was performed. It was difficult to decide the timing of CABG in this patient with multi- vessel disease.
