IVUS guided drug-coated balloon venoplasty for in-stent restenosis in pulmonary veins stenosis: a case report

Background pulmonary veins stenosis after atrial fibrillation radiofrequency ablation is an uncommon complication. When it occurs, percutaneous treatment is the preferred approach. There is a lack of standardized procedures, and when stenting restenosis is relatively common. Case summary we present a young patient with recurrence of pulmonary vein stenosis after a first percutaneous treatment. The recurrence of haemoptysis and dyspnoea after treatment in pulmonary vein stenosis allowed the diagnosis of significant stenosis again in our patient. In the Heart Team we opted for new percutaneous treatment, using IVUS to optimize the final result. Discussion nowadays, percutaneous approach is preferred and among percutaneous treatments for pulmonary veins stenosis, and stenting has shown better results than ballon angioplasty. Despite this, experience in instent restenosis is limited, and there is a lack of adequate and specific material for its approach. In this case we present the possible role of the IVUS and the drug-coated ballon angioplasty in this entity.