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Int J Angiol 2013; 22(01): 063-068
DOI: 10.1055/s-0033-1333869
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Successful Expansion of an Underexpanded Stent by Rotational Atherectomy

Lori Vales
1   Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
,
John Coppola
1   Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
,
Tak Kwan
2   Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York, New York
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Publikationsdatum:
05. Februar 2013 (online)

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Abstract

The current routine use of intracoronary stents in percutaneous coronary intervention (PCI) has significantly reduced rates of restenosis, compared with balloon angioplasty alone. On the contrary, small post-stenting luminal dimensions due to undilatable, heavily calcified plaques have repeatedly been shown to significantly increase the rates of in-stent restenosis. Rotational atherectomy of lesions is an alternative method to facilitate PCI and prevent underexpansion of stents, when balloon angioplasty fails to successfully dilate a lesion. Stentablation, using rotational atherectomy to expand underexpanded stents deployed in heavily calcified plaques, has also been reported. We report a case via the transradial approach of rotational-atherectomy–facilitated PCI of in-stent restenosis of a severely underexpanded stent due to a heavily calcified plaque. We review the literature and suggest rotational atherectomy may have a role in treating a refractory, severely underexpanded stent caused by a heavily calcified plaque through various proposed mechanisms.

Keywords

underexpanded stent - in-stent restenosis - rotational atherectomy - stentablation
 

  • References

  • 1 Mokabberi R, Blankenship JC. Rotational atherectomy to facilitate stent expansion after deployment in ST-segment-elevation myocardial infarction. Am Heart Hosp J 2010; 8 (1) 66-69
    PubMedSuche in Google Scholar
  • 2 Kobayashi Y, Teirstein PS, Linnemeier TJ, Stone GW, Leon MB, Moses JW. Rotational atherectomy (stentablation) in a lesion with stent underexpansion due to heavily calcified plaque. Catheter Cardiovasc Interv 2001; 52 (2) 208-211
    CrossrefPubMedSuche in Google Scholar
  • 3 Medina A, de Lezo JS, Melián F, Hernández E, Pan M, Romero M. Successful stent ablation with rotational atherectomy. Catheter Cardiovasc Interv 2003; 60 (4) 501-504
    CrossrefPubMedSuche in Google Scholar
  • 4 Sunew J, Chandwaney RH, Stein DW, Meyers S, Davidson CJ. Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent. Catheter Cardiovasc Interv 2001; 53 (4) 513-517 , discussion 518
    CrossrefPubMedSuche in Google Scholar
  • 5 Ho PC, Weatherby TM, Dunlap M. Burr erosion in rotational ablation of metallic coronary stent: an electron microscopic study. J Interv Cardiol 2010; 23 (3) 233-239
    CrossrefPubMedSuche in Google Scholar
  • 6 Sperling RT, Ho K, James D, Laham R, Gibson M, Carrozza J. Treatment of stent-jailed side branch stenoses with rotational atherectomy. J Invasive Cardiol 2006; 18 (8) 254-258
    PubMedSuche in Google Scholar
  • 7 Feldman T. Rotational ablation of stent metal components: the intersection between coronary intervention and auto body repair. Catheter Cardiovasc Interv 2001; 52 (2) 212-213
    CrossrefPubMedSuche in Google Scholar
  • 8 Reisman M, Shuman BJ, Harms V. Analysis of heat generation during rotational atherectomy using different operational techniques. Cathet Cardiovasc Diagn 1998; 44 (4) 453-455
    CrossrefPubMedSuche in Google Scholar