Hashemi, Arash; Karagöz, Ahmet; Gholoobi, Arash; Ghaffari, Lida; Ahmedieh, Arsis; Ucar, Melisa; Zoghi, Mehdi

ABSTRACT

Underexpansion is an important issue for interventional cardiologists in terms of long term results. Herein we report a successful rotablation of an under-expended stent struts. The patient was a 75 years old female with a history of Percutaneous Coronary Intervention (PCI) on Left Anterior Descending Artery (LAD) with 2 overlapping drug eluting stents a week ago in another center. Unfortunately, the stents were deployed without proper lesion preparation in heavily calcified lesions and hence the stents couldn't be dilated properly after deployment. The stent struts were successfully rotablated with 1.5 and 1.75 burrs respectively followed by subsequent stenting. The patient was discharged uneventfully. Under-expansion of a stent generally arises from inadequate lesion preparation. Impaired healing secondary to under-expanded stent struts is the main cause of re-stenosis in the short term. Hence adequate pre-dilatation especially in heavily calcified lesions is of quite importance. More sophisticated techniques such as Non-Compliant balloon (OPN), rotablation, shock wave balloon and laser should be used for adequate pre-dilatation when conventional balloon pre-dilatation methods fail. These methods can also be used for dilatation of an under-expanded stent. Consequently, under-expansion of a stent is one of the leading causes of stent restenosis. Rota-ablation can be used to debulk the under-expanded stent struts and hence prevent possible short term restenosis.

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