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

Feldman, Ted

doi:10.1002/1522-726x(200102)52:2<212::aid-ccd1050>3.0.co;2-9

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…Therefore, slow burr advancement without excessive deceleration and using short periods of lesion contact may be important in the success of the procedure. 22 Our case shows that the use of Rotablator was well tolerated and effective in treating an ISR lesion with underlying severe stent underexpansion and heavy plaque calcification. Intravascular ultrasound image poststenting.…”

Section: Commentmentioning

confidence: 80%

Stentablation of an underexpanded stent in a heavily calcified lesion using rotational atherectomy

Lee

Park²,

Kim³

2012

Journal of Cardiovascular Medicine

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Adjunctive technologies such as high-speed mechanical rotational atherectomy [(Rotablator), Boston Scientific Corporation, Natick, Massachusetts, USA] are useful in augmenting the results of percutaneous coronary intervention in certain situations. Although data from randomized prospective trials are scarce, it is generally accepted that Rotablator therapy can be useful in preparation of long, ostial and heavily calcified bifurcation lesions, 1 or lesions that cannot be crossed or dilated successfully owing to rigidity and/or excessive calcification of the proximal vessel. 2 We report a case in which Rotablator was successfully used to treat a pseudorestenosis lesion that developed owing to a severely underdeployed coronary stent. Methods and resultsA 68-year-old man with hypertension and hyperlipidemia presented with exertional angina. Seven months prior to admission, he had received percutaneous coronary intervention (PCI) in the proximal to mid-left anterior descending (LAD) coronary artery for acute myocardial infarction, using two drug-eluting stents [(Cypher), Cordis Corporation, Bridgewater, New Jersey, USA; 3.0 Â 18 mm and 2.75 Â 23 mm]. However, because of a hard lesion with severe calcification in the mid LAD, it was impossible to adequately dilate the stent despite multiple postdilatations at high pressure, and more than 50% residual stenosis remained. Research letterFig. 1Coronary angiogram at admission. In-stent restenosis with greater than 90% luminal narrowing, seen in the overlapping area of the previous two stents. Conventional balloon angioplasty was attempted, but passing the target lesion with the balloon catheter was not possible.

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Section: Commentmentioning

confidence: 80%

Stentablation of an underexpanded stent in a heavily calcified lesion using rotational atherectomy

Lee

Park²,

Kim³

2012

Journal of Cardiovascular Medicine

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“…Various mechanisms have been proposed to explain the facilitation of expansion of the stent. The most plausible of them seems to be heat generation leading to liquefaction of the calcified atheroma behind the stent struts that would facilitate the balloon expansion . Other possible cause may be the direct ablation of the metallic stent and fibrocalcific tissue …”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Hernández-Enrı́quez

Campelo‐Parada

Lhermusier

et al. 2018

J Interven Cardiology

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ObjectivesTo analyze the procedural and long‐term outcomes of the use of rotational atherectomy (RA) in underexpanded stents in our cohort and to provide an overview of currently available data on this technique.BackgroundStent underexpansion (SU) has been related to stent thrombosis and restenosis. RA has been used to treat undilatable SU as a bail‐out strategy with encouraging results.MethodsThis is an observational, single‐center study. We included patients who underwent stentablation between 2013 and 2017. Baseline demographics, procedural results, in‐hospital major adverse cardiac events (MACE), and long‐term follow‐up MACE were retrospectively collected.ResultsA total of 11 patients (90.9% males, mean age 65.4 ± 18.6) were included in this study. Median left ventricle ejection fraction was 53.5% [46.2‐55]. Median calculated Syntax score was 16 [9‐31] and 45.5% of patients were admitted for acute coronary syndrome. Radial approach was used in 63.6% of cases. Most patients only required one burr (45% used a 1.5 mm diameter burr) during the intervention. Procedural success was achieved in 90.9% of the cases. Acute lumen gain was 42.7% [30.7‐61.49]. There were no in‐hospital deaths or MACE. At a median follow‐up of 26 months, only one patient (9.1%) suffered MACE in the context of acute coronary syndrome, and two patients (18.2%) required non‐target lesion revascularization. No deaths were reported.ConclusionsRA of under expanded stents is a feasible option with a high rate of procedural success. At long‐term follow‐up, all of them were alive and 90.9% of patients remained free from MACE.

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“…The greatest concern with longitudinal stent ablation is to slip through the underexpanded stent without ablating the metal and leaving the burr immovable [10]. Hence, we advanced the burr more gradually and carefully than usual.…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report

Koide

Inoue

Matsuo

et al. 2016

BMC Cardiovasc Disord

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BackgroundHeavy coronary artery calcification is responsible for stent underexpansion, which is associated with increased in-stent restenosis. Here we report a case in which optical coherence tomography (OCT) demonstrated that the metal component of an underexpanded stent previously implanted in a heavy calcified lesion had been completely removed after ablation with rotational atherectomy.Case presentationAn 83-year-old man with exertional angina was referred to our hospital. Coronary angiography revealed severe stenosis in the proximal portion of the right coronary artery and left circumflex artery and chronic total occlusion (CTO) in the mid portion of the left anterior descending artery (LAD). We performed complete revascularization with percutaneous coronary intervention. Because the CTO lesion in LAD contained napkin-ring heavy calcifications, rotational atherectomy with a 1.75-mm burr was undergone, followed by the deployment of drug-eluting stents and postdilation with a high-pressure balloon. However, expansion of the stent was incomplete. To address the recurrence of in-stent restenosis and resistance to the dilation with the high-pressure balloon, we decided to simultaneously ablate both the heavy calcification and underexpanded stent. Longitudinal stent ablation with 1.75- and 2.0-mm burrs was successful, and OCT demonstrated that the metallic component of the underexpanded stent had been completely removed.ConclusionIf a stent fails to completely extend in heavy calcification, longitudinal stent ablation by rotational atherectomy could be an effective remedy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0419-8) contains supplementary material, which is available to authorized users.

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

Cited by 6 publications

References 6 publications

Stentablation of an underexpanded stent in a heavily calcified lesion using rotational atherectomy

Stentablation of an underexpanded stent in a heavily calcified lesion using rotational atherectomy

Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report

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