Acute Severe Ischemia Following Protected Distal Left Main Stenting for Recurrent Drug-Eluting Instent Restenosis: A Potential New Mechanism for Side-Branch Ischemia

Acute Severe Ischemia Following Protected Distal Left Main Stenting for Recurrent Drug-Eluting Instent Restenosis: A Potential New Mechanism for Side-Branch Ischemia

Left main coronary artery instent restenosis can be treated by repeat percutaneous intervention with drug-eluting stent. We report a 53- year old patient with protected left main disease who presented with recurrent drug-eluting instent restenosis of distal left main/left circumflex ostium. The patient required treatment with a third layer of drug-eluting stent, using the single-stent approach. Acutely following the procedure, the patient developed severe angina associated with 2-mm ST segment depression in electrocardiographic leads V1-V4. Re-look angiography demonstrated a patent stent and normal appearance of the ostium of left anterior descending artery. Plain balloon dilatation of the three-layers of stent-struts across the left anterior descending artery ostium completely relieved the ischemia.