Two Different Successful Angioplasty Methods in Patients with Stenotic Coronary Artery Ectasia
A 46-year-old man presented with resting chest pain. He had suffered from hypertension and dyslipidemia for 5 years and had a history of smoking. He had no significant findings on the electrocardiogram, in the echocardiography, or for cardiac enzymes.\nCAG via the right radial artery was performed. The angiographic findings showed severe tubular eccentric stenosis in the mid portion of the left circumflex artery (LCX) with ectatic change in both the left anterior descending artery (LAD) and LCX (). The RCA was relatively hypoplastic.\nElective percutaneous coronary angioplasty was planned. Because of ectasia in the target lesion as shown by the angiographic and intravascular ultrasound (IVUS) measurements (), we could not find a proper device size among the usual coronary balloons and stents. We decided to use a larger device commonly used in the peripheral artery.\nRight femoral artery puncture and guiding was performed with a 7F EBU 3.5 guiding catheter (Medtronic Inc., Minneapolis, MN, USA). Before percutaneous coronary angioplasty, the IVUS exam showed significant, eccentric plaque burden from the 5 o'clock to the 7 o'clock direction and the reference vessel diameter measured just distal to the target lesion was 6.2×6.8 mm (). In the mid LCX lesion, predilation was done with an Amiia PTA balloon catheter measuring 5.0×20 mm (Cordis Europa, N.V., Roden, Netherlands). After predilation, residual stenosis was approximately 55% to 60% with mild intimal dissection. A Genesis 6.0×24-mm stent (Palmaz® Genesis™, Cordis Europa, N.V.) was successfully deployed in the mid LCX lesion, and subsequent adjuvant ballooning was done for angiographic optimal stent expansion with an Amiia 7.0×20-mm balloon catheter (Cordis Europa, N.V.; ). Final coronary angiography and IVUS showed a well expanded and opposed Genesis stent ().\nThe patient no longer had chest pain and was safely discharged for clinical follow-up. He was placed on dual antiplatelet agents (aspirin and clopidogrel), a lipid-lowering agent (rosuvastatin), a calcium channel blocker (diltiazem), and trimetazidine. A routine follow-up CAG at 6 months showed patent previous stent in the mid LCX without in-stent restenosis (). After the follow-up CAG, aspirin monotherapy was maintained because the implanted peripheral stent was a bare metal stent.