Successful rotational atherectomy for a repetitive restenosis lesion with underexpansion of double layer drug-eluting st
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CASE REPORT
Successful rotational atherectomy for a repetitive restenosis lesion with underexpansion of double layer drug-eluting stents due to heavily calcified plaque Masahito Kawata • Yukinori Kato • Hiroki Takada • Kohei Kamemura • Akira Matsuura • Susumu Sakamoto
Received: 26 August 2014 / Accepted: 26 January 2015 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 72-year-old male was treated. First percutaneous coronary intervention (PCI) for chronic total occlusion of proximal left anterior descending artery was performed after rotational atherectomy with 1.5-mm burr. Focal underexpansion of Promus stent occurred due to the heavily calcified plaque. After first restenosis, OCT-guided PCI was performed with 26 atm balloon dilatation. After second restenosis, Resolute Integrity was implanted. After third restenosis, rotational atherectomy with 1.5-, 1.75- and 2.15-mm burrs was performed. All stent struts disappeared at the lesion and Promus Element was implanted. No restenosis occurred after 6 months. Cautious rotational atherectomy could ablate double layer drug-eluting stents effectively. Keywords Rotablator
Rotational atherectomy Stent Restenosis
Introduction Although drug-eluting stent (DES) remarkably reduced the stent restenosis [1], in-stent restenosis due to stent underexpansion remains to be the problem, especially in heavily calcified lesions [2]. Usually rotational atherectomy is used for calcified lesion before stent delivery [3]. However, in thick circumferential calcified lesion may cause stent underexpansion. This case report describes successful treatment of a lesion with double layer DESs restenosis three
M. Kawata (&) Y. Kato H. Takada K. Kamemura A. Matsuura S. Sakamoto Department of Cardiology, Akashi Medical Center, 743-33, Yagi, Ohkubo-cho, Akashi, Hyogo 674-0063, Japan e-mail: [email protected]
times due to underexpansion with heavily calcified plaque using rotational atherectomy.
Case A 72-year-old male with the third stent restenosis was admitted. First percutaneous coronary intervention (PCI) for chronic total occlusion of proximal left anterior descending artery was performed. Since intravascular ultrasound (IVUS) (Terumo Corp. Tokyo, Japan) did not pass the lesion, rotational atherectomy was performed. After ablation with Rotablator 1.5-mm burr (Boston Scientific Corp. MA, USA) three times (230000 rpm, maximum 10000 rpm down) IVUS was performed. There was some amount of superficial calcification nearly 360° but the layer was blurred and calcification did not seem so hard that we considered it to be dilated with balloon. Balloon dilatation was done with 2-mm semi-compliant balloon catheter. After 2.5 9 23 mm Promus stent (Boston Scientific Corp. MA, USA) was implanted with 12 atm, focal underexpansion occurred due to the calcified plaque. We postdilated the lesion with 2.5 mm non-compliant balloon catheter with the pressure of 25 atm. Final minimal luminal diameter (MLD) was 1.5 mm by IVUS. Ten months later 99 % stent restenos
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