In-stent restenosis (ISR) is said to be caused by under-expanded stent, neointima, etc., which can result in late stent thrombosis. Therefore preventing restenosis is an important problem in the DES era. This report presents a case of focal thrombi-related restenosis on everolimus-eluting stent confirmed by angioscopy and optical coherence tomography. Given that the management of in-stent restenosis on drug-eluting stent (DES) has not been established, intracoronary imaging tools would play an important role in the treatment of ISR after using DES. Intracoronary imaging tools will give a more accurate diagnosis and will help in the prevention and treatment of ISR.
A 66-year-old man with suspected ischemic heart disease was hospitalized for further investigation. Coronary angiography revealed 90% stenosis with calcification at the bifurcation of the first diagonal branch (D1) of the left anterior descending branch. Percutaneous coronary intervention (PCI) was performed and a guidewire was successfully passed through the stenotic lesion; however, during the introduction of a 2.5×6 mm balloon catheter, the patient suddenly experienced severe chest pain, became disturbed, and went into shock. Coronary angiography was immediately performed, but the left main coronary trunk was not visualized, and dissection was suspected. A microcatheter was successfully passed through the stenotic lesion, and blood collected from the right radial artery was forcibly pumped under pressure into the coronary artery via this microcatheter to improve coronary artery perfusion. The patient came out of shock and his electrocardiographic findings normalized. PCI could not be continued, thus coronary artery bypass grafting was performed, and pumping was continued for approximately 2 hours, after which the surgery was successful. Pumping arterial blood collected from the radial artery through a microcatheter, which passed through the coronary artery obstruction to improve circulatory status, was a highly effective treatment for an accident during PCI.