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Cardiovascular Intervention and Therapeutics

, Volume 33, Issue 4, pp 395–397 | Cite as

Optical frequency domain imaging-guided rotational atherectomy followed by drug-coated balloon dilation to the non-calcified lesion in a patient with severe thrombocytopenia

  • Jun Shiraishi
  • Muneo Ohshiro
  • Yuki Matsubara
  • Masayuki Hyogo
  • Hitoji Uchiyama
  • Takahisa Sawada
Images in Cardiovascular Intervention
A 77-year-old man with aplastic anemia was admitted to our hospital due to worsening heart failure. Approximately 1 year earlier, he underwent left main (LM)-left anterior descending coronary artery (LAD) crossover stenting with a bare metal stent (BMS) [ 1]. A routine blood test at admission showed pancytopenia (platelet 2000/μL, hemoglobin 6.3 g/dL, white blood cell 3120/μL) and coronary angiography (CAG) indicated a subtotal occlusion in the mid-distal right coronary artery (RCA) without in-stent restenosis of the BMS in LM-LAD (Supplementary Fig. 1). Because of refractory heart failure and severe thrombocytopenia, we performed transradial stentless percutaneous coronary intervention (PCI) against the RCA lesion after transfusions, using rotational atherectomy (RA) and drug-coated balloon (DCB) under aspirin and intravenous heparin (Fig.  1a). Pre-procedural optical frequency domain imaging (OFDI) showed diffuse fibrous plaque as well as micro channels and deep layered area with...

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest regarding the content of the manuscript.

Supplementary material

12928_2017_493_MOESM1_ESM.pdf (1.9 mb)
Supplementary Fig. 1 Panel a-c left CAG depicted a mild in-stent narrowing at the LAD takeoff and a stenosis in the just proximal intermediate branch (black arrow), in addition to total occlusion in the mid LCx (white arrows) (Panel a, right anterior caudal view; Panel b, left anterior caudal view; Panel c, anterior-posterior cranial view). Panel d IVUS image of the LAD takeoff showed a mild in-stent intimal thickening without significant lumen narrowing. (PDF 1913 kb)
12928_2017_493_MOESM2_ESM.pdf (2.2 mb)
Supplementary Fig. 2 Pre-procedural (Panel a-c, equivalent to Panel g-i in Figure 1), post-ablation with 1.5 mm burr (Panel d-f, corresponding to Panel a-c), post-ablation with 1.75 mm burr (Panel g-i, corresponding to Panel a-c), and post-DCB short-axis images (Panel j-l, corresponding to Panel a-c, equivalent to Panel j-l in Figure 1) of OFDI. (PDF 2299 kb)

References

  1. 1.
    Nishikawa M, Shiraishi J, Ohshiro M, Yashige M, Hyogo M, Sawada T. Left main crossover stenting in a patient with severe thrombocytopenia due to aplastic anemia. Cardiovasc Interv Ther. 2016. doi: 10.1007/s12928-016-0445-6.CrossRefPubMedGoogle Scholar
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    Kleber FX, Schulz A, Waliszewski M, Hauschild T, Böhm M, Dietz U, et al. Local paclitaxel induces late lumen enlargement in coronary arteries after balloon angioplasty. Clin Res Cardiol. 2015;104:217–25.CrossRefGoogle Scholar
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    Shiraishi J, Matsubara Y, Yanagiuchi T, Shikuma A, Shoji K, Nishikawa M, et al. Rotational atherectomy followed by drug-coated balloon dilation in possible coronary sequelae of Kawasaki disease. Int Heart J. 2016;57:367–71.CrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2017

Authors and Affiliations

  • Jun Shiraishi
    • 1
  • Muneo Ohshiro
    • 2
  • Yuki Matsubara
    • 1
  • Masayuki Hyogo
    • 1
  • Hitoji Uchiyama
    • 2
  • Takahisa Sawada
    • 1
  1. 1.Department of CardiologyKyoto First Red Cross HospitalKyotoJapan
  2. 2.Department of HematologyKyoto First Red Cross HospitalKyotoJapan

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