Successful Treatment of an Under Expanded Stent using Rotational Atherectomy: First Reported Case of Stent Ablation From Pakistan

Abstract

Background: Patients with under expanded coronary stents due to coronary artery calcification are at an increased risk of cardiovascular morbidity and mortality. Importantly, these present a challenging subset patients undergoing percutaneous coronary intervention. Rotational atherectomy is a time-tested technique to treat coronary artery calcification. However, its utilitization in treating under expanded coronary stents due to coronary artery calcification remains fraught with uncertainty amid the perceived risk of complications.

Case Presentation: We present the case of an 80-year old patient with a previously deployed under expanded coronary stent in his right coronary artery who presented with an acute coronary syndrome to our institute. Coronary angiography revealed severe instent restenosis and the lesion proved to be non-dilatable.

Management and Results: This patient underwent successful rotational atherectomy with a 1.75 mm burr at 160,000 revolutions per minute (rpm) to treat the severe instent restenosis and underexpanded stent (stent ablation) with satisfactory subsequent lesion dilatation followed by another drug eluting stent implantation.

Conclusion: Rotablation remains a viable option to treat under expanded stents as well as non-dilatable in stent restenosis. However, care must be exercised using this technique to avoid the risk of burr entrapment while treating under expanded stents.