Bail-out rotational atherectomy to ablate stent struts after treatment of a LAD bifurcation lesion with the trousers technique

Abstract

We present a previously unreported complication of the "trousers" stent procedure used for treatment of a bifurcation lesion in the left anterior descending artery and the first diagonal branch. Closure of the main vessel occurred. A balloon, however, could not be advanced across the side-branch stent to open the struts toward the main branch. Therefore, a bailout rotational atherectomy was performed to ablate the stent that then allowed a further dilatation with a PTCA balloon. This procedure resolved a potentially lethal outcome for the patient who subsequently underwent uneventful coronary by-pass grafting.

Transverse partial stent ablation with rotational atherectomy for suboptimal culotte technique in left main stem bifurcation

“…A similar strategy was already reported in the bare metal stent era by two different groups to resolve a failed bifurcation treatment , although it was not described in the LMS bifurcation. Moreover, the theoretical feasibility of “transverse” stent ablation has also been showed by Oda et al in a bench model describing the actual loss and deflection of stent struts by applying this strategy, with detachment of ablated metallic particles ranging in size from 1.7 mm for slotted stents up to 17.6 mm for coiled stents .…”

Rotational ablation of stent metal components: The intersection between coronary intervention and auto body repair

“…This report is unique in that it characterizes longitudinal ablation of the stent. Prior reports have described ablation through the side of the stent to relieve obstruction or jailing of a side-branch vessel [2][3][4][5]. The obvious significant difference is the larger amount of metal that must be ablated to achieve longitudinal release of the circumferential constraints of a stent.…”

Guidelines for repeat PCI in patients with previously deployed stents

“…When unable to cross into a side branch through a stent with a balloon (assuming the wire has crossed the stent struts), rotational atherectomy, using a small burr, may be effective in creating a channel through the struts, eventually allowing a balloon to cross the struts [1,2].…”