In-stent restenosis (ISR) remains a challenging problem, and its optimal management is still unknown. Although redilatation has predominantly been used, unusual complication such as coronary artery dissection may occur. This report describes successful surgical treatment of a severe coronary artey dissection in the left anterior descending coronary artery after attempting eximer laser angioplasty for in-stent restenosis.
___
1. Versaci F, Qaspardone A, Tomai F, Crea F, Chiariello L, Qioffre PA. A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery. M Engl J Med 1997-,536:817-822. 2. Bairn D, Levine MJ, Leon MB, Levine S, Ellis SJ, Schatz RA. Management of restenosis within the Palmaz-Schatz coronary stent (the U.S. multicenter experience: the U.S. Palmaz- Schatz Stent investigators). Am J Cardiol 1993/71:364-366. 3. Klues HQ, Radke PW, Hoffman R, von Dahi J. Pathophysiology and therapeutic concepts in coronary restenosis. flerz 1997:22:322-334. 4. Ghazzal ZMB, fleam JA, Litvack F, et al. Morphologic predictors of acute complications after percutaneous eximer laser coronary angioplasty: results of comprehensive angiographic analysis: importance of the eccentricity index. Circulation l992;86:820-827. 5. Eltchaninoff fi, Koning R, Tron C, Gupta V, Cribier A. Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and six-month angiographic recurrent restenosis rate. J Am Coll Cardiol 1998,-32:980-984. 6. Al-Sergani MS, fio PC, riesto RW, et al. Stenting for in-stent restenosis: a long-term clinical follow-up. Catheter Cardiovasc Interv 1999,-48;143-148. 7. Mahdi HA, Pathan AZ, flanel L, et al. Directional coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis. Am J Cardiol 1998;82:1345-1352. 8. Mehran R, Mintz GS, Satler LF, et al. Treatment of in-stent restenosis with eximer laser coronary angioplasty: mechanism and results compared with PTCA alone. Circulation 1997,-96:2183-2189. 9. Waksman R, Bhargava B, White L, e t al. Intracoronary beta-radiation therapy inhibits recurrence of in-stent restenosis. Circulation 2000; 101:1895-1898. 10. Radke PW, worn Dahl J, Klues tiG. Stent restenosis: therapy concepts and possibilities for prevention. Med Klin 1999,-94:88-92. ll.Köster R, flamm CW, Terres W, e t al. Treatment of in-stent coronary restenosis by eximer laser angioplasty. Am J Cardiol 1997,-80:1424-1428. 12. Moustapha A, Assali AR, Sdringola S, et al. Percutaneous and surgical interventions for in-stent restenosis: long-term outcomes and effect of diabetes mellitus. J Am Coll Cardiol 2001 ;37:1877-1882.