Drug-eluting stent for recurrent mesenteric artery in-stent restenosis.
OBJECTIVE
To report the use of a drug-eluting stent (DES) for treatment of symptomatic in-stent restenosis (ISR) in the superior mesenteric artery (SMA).


METHODS
A 79-year-old woman suffering from chronic renal failure and needing dialysis was admitted for vomiting, postprandial abdominal pain, and weight loss for 3 months. Computed tomographic angiography (CTA) documented massive calcification of the vascular bed, mainly in the aorta, and a very tight ostial stenosis of the SMA. A 4.5-x20-mm Genesis stent was deployed at the ostium, with good angiographic result and immediate symptomatic benefit. After 3 months, symptoms recurred; angiography demonstrated ISR. Percutaneous angioplasty with a 4-x15-mm cutting balloon was performed. The patient remained asymptomatic for only 2 months; recurrent ISR at this time was treated with a 3.5-x24-mm coronary TAXUS Express paclitaxel-eluting coronary stent deployed inside the previously implanted stent. Under prolonged double antiplatelet regimen, the patient was asymptomatic at the 8-month follow-up; CTA demonstrated patency of the SMA.


CONCLUSIONS
Considering the high rate of restenosis and the periprocedural complications described with endovascular treatment of SMA stenosis, a drug-eluting stent may be a good option not only for the treatment of restenosis but also in de novo lesions, at least when the vessel diameter is <4.5 mm.
Cardaioli
Paolo
P
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy. cardaioli.paolo@azisanrovigo.it
Rigatelli
Gianluca
G
Zattoni
Luca
L
Giordan
Massimo
M
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; D017239:Paclitaxel