Rotational Atherectomy of Three Overlapping Stent Layers

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Device Technology

Background:

• Recurrent angina pectoris can significantly impair quality of life.
• In-stent restenosis is a known complication following percutaneous coronary intervention.
• Underexpanded stents can contribute to restenosis and suboptimal outcomes.

Observation:

• A patient presented with Canadian Cardiovascular Society class III refractory angina.
• Imaging revealed in-stent restenosis within multiple underexpanded stents implanted over several years.
• The patient had a history of stents implanted in 2004, 2011, and 2014.

Findings:

• Rotational atherectomy was performed to address the complex in-stent restenosis.
• The procedure achieved successful stent strut ablation, reducing multilayered struts to a single layer.
• Significant lesion expansion and excellent angiographic and physiological results were observed post-intervention.

Implications:

• Rotational atherectomy is a viable treatment option for complex in-stent restenosis with underexpanded stents.
• This technique can restore vessel patency and improve clinical symptoms in challenging cases.
• Successful stent ablation and expansion may reduce future restenosis events and improve long-term cardiovascular health.