Rotational atherectomy: if you do not do it before, you can do it after stenting

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Medical Imaging

Background:

• Percutaneous coronary intervention (PCI) aims to restore coronary blood flow.
• Underexpanded stents, particularly in heavily calcified lesions, pose a significant challenge.
• Achieving optimal stent expansion is crucial for long-term outcomes.

Observation:

• Three cases of severely underexpanded freshly deployed stents in the proximal left anterior descending artery were observed.
• High inflation pressure (24 atm) failed to achieve adequate stent expansion.
• Heavily calcified plaque was identified as the primary cause of stent underexpansion.

Findings:

• Rotational atherectomy with a high RPM and stepped burr strategy effectively ablated the underexpanded stent layers and calcified plaque.
• Subsequent balloon angioplasty achieved satisfactory stent expansion.
• Final scaffolding with an additional stent resulted in an excellent angiographic result.

Implications:

• Rotational atherectomy is a valuable technique for managing severely underexpanded stents in complex calcified lesions.
• This approach can salvage challenging PCI cases, preventing adverse events.
• Successful stent expansion is achievable even in the presence of severe calcification using adjunctive atherectomy.