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Case Reports
. 2010 Aug;20(3):165-9.
doi: 10.1007/s00062-010-0012-y. Epub 2010 May 29.

Recurrent in-stent restenosis in a symptomatic nonatherosclerotic M1 plaque : successful treatment with paclitaxel-eluting balloon dilatation after repeated failure of conventional balloon reangioplasty

T Güthe, E Miloslavski, Z Vajda, J Peters, H Bäzner, H Henkes
Case Reports

Recurrent in-stent restenosis in a symptomatic nonatherosclerotic M1 plaque : successful treatment with paclitaxel-eluting balloon dilatation after repeated failure of conventional balloon reangioplasty

T Güthe et al. Clin Neuroradiol. 2010 Aug.
No abstract available

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Figures

Fig. 1
Fig. 1
Initial thrombus narrowing the left M1 segment (a). One day later under systemic heparinization and dual platelet inhibition, the thrombus was resolved and a long plaque extending from the distal ICA to the proximal MCA became visible (b). Despite continued medication, DSA 3 days later again showed a critical vessel narrowing (c). Conventional balloon dilatation and deployment of an Enterprise stent restored the vessel diameter with some degree of residual stenosis of the distal ICA and the M1 segment (d). The plaque itself remained visible. There was a preexisting high-grade stenosis of the proximal A1 segment, which remained untreated since the left ACA was supplied from both sides
Fig. 2
Fig. 2
Angiographic follow-up and three conventional retreatments. The three follow-up examinations were carried out 77 days (a), 135 days (c), and 225 days (e) after the initial treatment. Each of the three conventional balloon angioplasties was successful without any relevant residual stenoses (b, d, f). Only 44 days after the third conventional balloon angioplasty, the next ISR was found. In the meantime, the left proximal A1 segment was occluded without clinical sequels
Fig. 3
Fig. 3
ISR of the left distal ICA and proximal MCA 275 days after initial stent PTA (Enterprise) and three conventional retreatments (a). The ISR was treated by gentle DEB angioplasty (b). Further angiographic follow-up 273 days after DEB treatment showed a widely patent and smooth vessel lumen (c)
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