An Underexpanded Stent Does not Forgive

Abstract

Resistant coronary lesions regularly challenge physicians performing percutaneous coronary interventions (PCI) and specific techniques may be required to achieve procedural success. Underestimation of a resistant lesion may result in implanting an underexpanded stent due to insufficient plaque modification. Stent underexpansion is a risk factor for stent thrombosis and particularly difficult to treat. We present herein a case of a resistant right coronary artery lesion, insufficiently modified before stenting and finally treated with an underexpanded stent which could not be expanded by balloon post-dilatation at the initial intervention. Two inferior wall myocardial infarctions ensued one and three years later, both due to stent thrombosis despite intensive dual antiplatelet therapy and both treated by primary PCI. The stent could only be expanded by aggressive non-compliant balloon dilatation at the last procedure. The case presentation is followed by a brief discussion concerning techniques to successfully treat resistant coronary lesions and underexpanded stents.