Use of rotational atherectomy for treatment of in-stent restenosis with coronary double-mesh stent underexpansion. Case report

Daniel Freitas,Giulliano Gardenghi,Flavio Barbosa,Maurício Prudente,Patrícia Demuner,Débora Rocha

doi:10.31160/jotci202230a20210034

Abstract

Treatment of in-stent restenosis lesions, especially calcified lesions, with stent underexpansion, generally requires more complex techniques, such as rotational atherectomy. The case reported is a male patient with a 99% in-stent focal restenosis lesion at the origin of the first diagonal branch, where two stents were implanted 14 years ago. After failure of balloon angioplasty alone, ablation of the plaque and part of the stent struts was performed using the rotational atherectomy technique, which allowed the implantation of a new stent which was totally expanded.

Highlights

Percutaneous coronary intervention (PCI) with stent implantation is a technique widely used since the 1990s for the treatment of obstructive coronary lesions caused by atheromatous plaques
Calcified lesions deserve special attention, as they are often associated with stent underexpansion, because the balloons used for their expansion are not capable of causing the expected increase of the struts over the vessel lumen, considering the irregularities resulting from the calcifications.[1]
We show the use of the rotational atherectomy (RA) technique for the treatment of a calcified plaque and the ablation of a double mesh stent placed over the lesion, followed by an everolimus-eluting stent (EES) implantation

Summary

CASE REPORT

Use of rotational atherectomy for treatment of in-stent restenosis with coronary double-mesh stent underexpansion. Uso de aterectomia rotacional para tratamento de reestenose intra-stent com subexpansão de dupla malha de stents coronarianos. ABSTRACT – Treatment of in-stent restenosis lesions, especially calcified lesions, with stent underexpansion, generally requires more complex techniques, such as rotational atherectomy. The case reported is a male patient with a 99% in-stent focal restenosis lesion at the origin of the first diagonal branch, where two stents were implanted 14 years ago. RESUMO – O tratamento de lesões reestenóticas intra-stent, principalmente as calcificadas, com subexpansão do stent, geralmente requer o uso de técnicas mais complexas para sua execução, como a aterectomia rotacional. O caso se trata de um paciente do sexo masculino com lesão reestenótica focal intra-stent de 99% na origem do primeiro ramo diagonal, local onde foram implantados dois stents há 14 anos. Após falha da angioplastia apenas com balões, realizou-se a ablação da placa e de parte das hastes dos stents pela técnica de aterectomia rotacional, o que possibilitou o implante de novo stent com sua expansão total

INTRODUCTION

DISCUSSION