Simultaneous Transradial Coronary and Renal in Stent Restenosis Treatment in Diabetic Patient with NSTEMI Complicated by Hypertensive Emergency

The elderly diabetic patients are increasingly referred for percutaneous coronaryinterventions during acute coronary syndromes. A nonegligible proportion ofthis population includes the in stent restenosis as a possible cause of ischemicsyndrome. This population accounts an higher risk of ischemic, bleeding and vascularcomplications affecting the periprocedural management, the length of hospitalstay and also the prognosis. The improvement of strategies concerning site of accesschoice, antithrombotic drug and timing of interventional treatment have significantlyreduced the incidence of complications. This paper reports the case of a 76 years-olddiabetic female with a high bleeding risk, referred to our hospital because of NSTEMIcomplicated by pulmonary edema during hypertensive emergency. The patient had asimultaneous in stent restenosis both in left descending coronary artery and left renalartery, undergoing percutaneous transradial treatment during bivalirudin infusion.The clinical, technical, pharmacological and prognostic implications are discussed.