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Updated: Nov 20, 2025

Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Optical coherence tomography-guided management of underexpanded stent in calcified coronary lesion
Ankush Gupta1, Sanya Chhikara2, Navreet Singh3
1Department of Cardiology, Military Hospital Jaipur, Jaipur, India.
Abstract:
Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm2 and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm2 and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.
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