Description of Event or Problem · 1
IT WAS RPEORTED 101 DAYS AFTER IMPLANTATION OF THREE TAXUS EXPRESS2 DRUG ELUTING STENTS, IN-STENT RESTENOSIS OCCURRED. DURING THE INITIAL PROCEDURE A 95% TO 99% STENOTIC LESION LOCATED IN THE PROXIMAL LEFT ANTERIOR DESCENDING (LAD) ARTERY AND INVOLVING THE OSTIAL 2ND DIAGONAL ARTERY WAS TREATED SUING A KISSING BALLOON TECHNIQUE WITH TWP 2.5X15 MM BALLOONS INFLATED TO 8ATM'S. NO INFORMATION WAS RECIEVED REGARDING THE LAD AND INFATED TO 14 ATM'S FOR 1 MINUTE. NEXT, A 2.5X15 MM BALLOON WAS PLACED IN THE OSTIAL AND PROXIMAL SECTION OF THE 2ND DIAGONAL ARTERY AND INFALTED TO 8 ATM'S FOR 1 MINUTE. AFTER BALLOON DILATION, A 2.5X 12 TAXUS STENT WAS DEPLOYED IN THE OSTIAL NAD PROXIMAL SECTION FOR THE 2ND DIAGONAL ARTERY AND INFALTED TO 14 ATM'S FOR 1 MINUTE. AFTER THE 2.5X12 MM TAXUS STENT WAS PLACED IN THE 2ND DIANONAL ARTERY, IT WAS NOTED THAT THERE WAS INSUFFICIENT OSTIAL LESION COVERAGE AS WELL AS A DISSECTION IN THE 2ND DIAGONAL ATERY. SUBSEQURNTLY, AN ADDITIONAL 2.5X12 MM TAUS STENT WAS PLACED IN THE 2ND DIAGONAL ARTERY OVERLAPPING THE PREVIOUSLY PLACED 2.5X12 MM TAXUS STENT AND DILATED TO 14 ATM'S FOR 1 MINUTE, FOLLOWED BY KISSING BALLOON POST-DILATION TO THE LAD AND THE 2ND DIAGONAL. A FINAL ANGIOGRAM SHOWED A SMALL LINEAR DISSECTION IN THE LAD PROXIMAL TO THE PREVIOUSLY DEPLOYED 2.5X24 TAXUS STENT. THE LESION IN THE LAD HAS A TIMI GRADE 3 FLOW THE PT WAS SYMPTOMS FREE, WITHOUT HEMODYNAMIC CONSEQUENCE, THEREFORE THIS DISSECTION NOT TREATED. POST-INTERVENTION STENOSIS IN THE STENTED SECTIONS WAS REPORTED AS 0% FOR THE LAD AND "NO RESIDUAL STENOSIS" FOR THE 2ND DIAGONAL ARTERY. THE PT RECEIVED ANGIOMAX DURING THE PROCEDURE, NO INFORMATION WAS REPORTED CONCERNING PT FOLLOW-UP MEDICATIONS OR COMPLICATIONS. THE PT PRESENTED 101 DAYS AFTER THE INITIAL PROCEDURE WITH A 99% IN-STENT RESTENOSIS IN THE LAD AND THE 2ND DIAGONAL. TWO CHOICE WIRES USED TO CROSS THE LAD AND THE 2ND DIAGONAL ARTERY. TWO 1.5X15 MM MAVERICK BALLOON WERE INFLATED IN THE LAD AND THE 2ND DIAGONAL ARTERY. SUBESEQUENTLY, TWO 2.0X24 NON-COMPLAINT BALLOONS WERE USED TO DILATE THE VESSELS. USING A KISSING BALLOON TECHNIQUE, A 2.5X24MM TAXUS STENT WAS DEPLOYED IN THE LAD AND 2.5X24 MM TAXUS STENT WAS DEPLOYED IN THE 2ND DIAGONAL ARTERY. POST-INTERVENTION WAS RESULTS WERE REPORTED AS 0% STENOSIS IN THE LAD AND 0% STENOSIS FOR THE 2ND DIAGONAL ARTERY. THE PT WAS PLACED ON PLAVIX AND CURRENT HOME MEDICATIONS. THE PT WAS SCHEDULED FOR FURTHER ANGIOPLASTY 2-3 WEEKS POST PROCEDURE.