Rotablating Atherectomy for Treatment of Unexpanded Stent at Heavily Calcified Lesion

- Operator : Seung-Jung Park

Rotablating Atherectomy for Treatment of Unexpanded Stent at Heavily Calcified Lesion

- Operator: Seung-Jung Park, MD
Patient presentation

A 55 year old man was admitted with effort angina for 3 months. He had diabetes mellitus and hypertension for coronary risk factors. Baseline coronary angiogram (CAG) showed three-vessel disease. After stenting in the left anterior descending and circumflex arteries with Cypher stents, we tackled the proximal right coronary artery (RCA) lesion.

Procedure

Right coronary ostium was engaged with an 8Fr AL2 guiding catheter. The CAG showed diffuse calcified narrowing of the proximal RCA (Image 1). The lesion was predilated with a Black-Hawk balloon (2.5 x 20 mm). Fluoroscopic indentation at the center of balloon was not relieved at 20 atm (Image 2). In spite of the residual indentation, we intended to put a stent because the lesion did not look serious. So, a Cypher stent (3.5 x 28 mm) was deployed at the lesion (Image 3), but unexpanded (Image 4). We tried repeated high pressure balloon dilatations with a non-compliant Quantum balloon (2.5 x 8 mm) up to 30 atm (Image 5). However, the stent was not dilated due to the heavy calcification (Image 6). Therefore, we performed rotablating atherectomy as a rescue procedure using 1.5 and 2.5 mm burrs (Image 7). Following angiogram showed slightly widened lumen (Image 8). IVUS showed discontinuation of the grinded stent strut (Movie 1). Then, another Cypher stent (3.5 x 13 mm) was deployed at the bared site with following high pressure balloon dilatation with a Maverick balloon (3.0 x 12 mm) at 20 atm (3.6 mm) (Image 9). The final angiogram showed a successful result (Image 10).

Leave a comment

Sign in to leave a comment.