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Background: Renal artery stent restenosis remains a significant impediment that in part is attributed to suboptimal stent deployment. We tested the hypothesis that optimal stent deployment during renal artery interventions can be achieved using the Metricath (MC) system, a balloon-catheter sizing device., Methods: The MC low-pressure balloon derives accurate vessel lumen dimensions from the three-dimensional reconstruction of volume of fluid and pressure within the inflated balloon. We systematically compared the final visual assessment of renal artery intervention with a subsequent MC minimal lumen diameter (MLD) in patients undergoing renal artery stenting., Results: Sixteen patients underwent angioplasty and stenting of 20 renal artery lesions. MC guidance resulted in adjunctive intervention in 90% of lesions, increasing MLD from 4.40 +/- 0.77 mm before to 5.17 +/- 0.82 mm (p < 0.001) after adjunctive intervention. The MC MLD to the angiographic reference vessel diameter improved from 77.4 +/- 15.2% to 91.2 +/- 17.5% (p < 0.001), and the MC MLD to the nominal stent diameter improved from 76.2 +/- 7.1% to 90.0 +/- 9.4% (p < 0.001) after adjunctive intervention. Stent expansion was more pronounced at its distal site compared to the lesion site where the postinterventional distal stent MLD was 5.52 +/- 0.93 mm (p = 0.23), and the lesion MLD was 5.17 +/- 0.82 (p = 0.001) compared to a nominal stent diameter of 5.78 +/- 0.88 mm. An MC MLD-to- nominal stent diameter ratio greater than or equal to 85% occurred in 10% of lesions before adjunctive dilatation and in 65% of lesions after adjunctive balloon post dilatation., Conclusions: MC guidance during renal interventions revealed a large proportion of underdeployed stents that were further optimized by adjunctive intervention.

We report the first case of in-stent re-stenosis in a sirolimus-coated stent in a heart transplant recipient with allograft vasculopathy. A 54-year-old male transplant recipient with new lesions in the left anterior descending artery detected during a routine surveillance catheterization was treated with two sirolimus-coated stents. Three months later he presented with dyspnea on exertion, and a repeat left heart catheterization demonstrated a focal area of in-stent stenosis in the proximal stent, which was treated with a cutting balloon.

The experience of brachytherapy in the treatment of in-stent restenosis of allograft arteries is limited. We present two cases of in-stent restenosis treated with brachytherapy with favorable angiographic follow-up at 10 months in one patient and at 17 months in the other., (Copyright 2004 Wiley-Liss, Inc.)

The pedicled right gastroepiploic artery is used as an arterial conduit in a select group of patients undergoing coronary artery bypass grafting with favorable patency and survival rates. Myocardial ischemia can occur, especially secondary to distal anastomotic stenosis. Percutaneous coronary interventions have been successful in treating these stenoses, precluding further challenging and higher risk operations. The restenosis rate of such interventions is unknown. We describe a case of distal right gastroepiploic graft anastomotic stenosis that was initially treated with percutaneous angioplasty, but later required stenting for restenosis. Subsequent in-stent restenosis was successfully treated with angioplasty and brachytherapy via the left axillary approach.