Knob balloon as a tool for intracoronary imaging guided in-stent restenosis treatment: A case report

Cardiovascular Revascularization Medicine: Interesting Cases Pub Date : 2025-07-30 DOI:10.1016/j.crmic.2025.100094

Enrico Cerrato , Simone Zecchino , Giulia Alagna , Giulia Nardi , Hector M. Garcia-Garcia , Nieves Gonzalo , Ferdinando Varbella

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Abstract

We report the case of a 64-year-old male patient, symptomatic for crescendo angina, admitted for elective coronary angiography with a finding of significant In-Stent Restenosis (ISR) of the mid Left Anterior Descending (LAD). Optical Coherence Tomography (OCT) imaging analysis confirmed the fibrotic nature of the ISR (biological mechanism) determined by intimal hyperplasia (biological mechanism). Following this findings, Knob balloon (GRIP TT, Acrostak, Switzerland) was used followed by non-compliant (NC) balloon at high atmosphere and final Drug Coated Balloon elution with optimal lumen gain.

Learning objective

This case highlights the value of OCT in accurately identifying the underlying mechanism of ISR, enabling a tailored, case-specific treatment strategy. Following knob balloon dilatation, effective plaque modification was obtained, allowing consequent stability during NC balloon inflation as well an improved deliverability of anti-proliferative agent and subsequent tissue retention in the restenotic area, possibly contributing to improved clinical outcomes and a reduced risk of recurrent restenosis.

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旋钮球囊作为冠脉内成像引导支架内再狭窄治疗的工具：1例报告

我们报告一例64岁男性患者，渐强性心绞痛症状，接受选择性冠状动脉造影，发现明显的支架内再狭窄（ISR）左前降段中部（LAD）。光学相干断层扫描（OCT）成像分析证实了由内膜增生（生物学机制）决定的ISR的纤维化性质（生物学机制）。根据这些发现，使用Knob球囊（GRIP TT, Acrostak, Switzerland），然后在高气压下使用非合规球囊（NC），最后使用最佳流明增益的药物涂层球囊洗脱。学习目标本病例强调了OCT在准确识别ISR的潜在机制方面的价值，从而实现量身定制的、针对具体病例的治疗策略。旋钮球囊扩张后，获得了有效的斑块修饰，使NC球囊膨胀期间的稳定性以及抗增殖剂的输送能力和随后再狭窄区域的组织保留得到改善，可能有助于改善临床结果和降低再狭窄复发的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Cardiovascular Revascularization Medicine: Interesting Cases

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