One cocr zotarolimus-eluting stent (zes) was implanted in the proximal to mid rca to treat the restenosis.Four overlapped cocr zes were also implanted from the mid lad to left main to treat restenosis.Six months later, patient presented with severe restenosis at both vessels.Due to recurrent and aggressive restenosis, metal allergy was suspected.The patient revealed previous contact dermatitis and a specific test confirmed nickle allergy.After the finding, pci with paclitaxel eluting balloons was performed with good final result.Six months later, a cardiac tomography scan revealed severe anterior ischemia.Coronary angiography revealed critical restenosis at ostial lad, and severe restenosis at mid lad with an occluded distal vessel.The rca presented a moderate restenosis at mid and distal segment.Coronary artery bypass grafting (cabg) was performed with a left internal mammary artery (lima) to cx and with saphenous vein graft (svg) to the posterolateral branch of the rca.Two months later, the patient presented a non st elevation myocardial infarction complicated with cardiogenic shock.An emergent ca showed an occlusive restenosis of ostial lad and proximal rca and a critical stenosis of the ostial cx, svg was occluded.Pci was carried out using bioresorbable vascular scaffold (bvs) at lm-cx and a prescription of prednisolone daily.After six months, patient remains asymptomatic.Angiographic follow-up showed neither restenosis nor thrombosis of bvs and improvement of collateral circulation to rca and lad.
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