Treatment of restenosis after bare-metal and drug-eluting stenting of an aorto-ostial lesion: challenges associated with excessive stent overhang.

Percutaneous coronary interventions of ostial right coronary artery stenoses are associated with increased procedural complications as well as with higher rates of angiographic and clinical restenosis. Ideally, the ostium is treated by positioning the stent with a slight degree of overhang in the aorta to ensure coverage of the aorto-ostial junction. This can potentially complicate further intervention should restenosis occur. We report a case in which in-stent restenosis of an overhanging stent had been treated with an also overhanging sirolimus-coated Cypher stent (Cordis Corporation, Roden, The Netherlands). Late repeat restenosis was treated with a third (Taxus, Boston Scientific, Maple Grove, Minnesota, USA) stent that was deployed through the previously implanted stent struts.