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

Lee, Sahmin; Park, Kyung Woo; Kim, Hyo–Soo

doi:10.2459/jcm.0b013e328339d924

Cited by 11 publications

(3 citation statements)

References 21 publications

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“…There is limited evidence for best practice in this situation and others have previously reported similar situations as ours [5,6], with similar clinical outcomes. Ideally the operators should take every necessary precaution to prevent the situation of an underdeployed stent, including ensuring adequate predilatation and ensuring sufficient balloon expansion, and also using IVUS to better understand the lesion anatomy as calcium burden may easily be underestimated.…”

Section: Discussionsupporting

confidence: 51%

Stentablation as a Successful Treatment Strategy for Stent Underdeployment due to Calcified Plaque

Rk¹,

Bourantas²,

Sd³

et al. 2012

J Clinic Experiment Cardiol

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Underexpansion of coronary stents represents an increased risk for subsequent stent thrombosis. Rotational artherectomy is now a commonly used technique to reduce the calcium burden in heavily calcified plaques prior to stent deployment. However, once deployed in such plaques prior to rotablation, stent underexpansion may be a challenge and dilemma exists on how best to deal with this clinical situation. In this report we describe a case where an underexpanded stent due to a heavily calcified plaque was successfully treated with stentablation, allowing for full stent expansion afterwards. Figure 1: A-The initial appearance of the right coronary artery. B-Appearance following initial wiring and balloon dilatations.

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Section: Discussionsupporting

confidence: 51%

Stentablation as a Successful Treatment Strategy for Stent Underdeployment due to Calcified Plaque

Rk¹,

Bourantas²,

Sd³

et al. 2012

J Clinic Experiment Cardiol

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“…Stentablation, meaning the use of RA to treat SU, has been used as a bail‐out strategy with encouraging results . Nevertheless, data about the long‐term clinical outcomes of this approach are limited to a few case reports and two recently published series .…”

Section: Introductionmentioning

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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“…Optimal treatment outcomes in these indications may be achieved by using IVUS-guided PCI. Other rare indications for using RA include inadequate expansion of a metal stent or bioresorbable scaffold (stent ablation and scaffold ablation) [45,46]. Contraindications to RA are presented in Table 2.…”

Section: Indications For and Contraindicationsmentioning

confidence: 99%

Rotational atherectomy in everyday clinical practice. Association of Cardiovascular Interventions of the Polish Society of Cardiology (Asocjacja Interwencji Sercowo-Naczyniowych Polskiego Towarzystwa Kardiologicznego — AISN PTK): Expert opinion

Dobrzycki¹,

Reczuch²,

Legutko³

et al. 2018

Kardiol Pol

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The common use of stents, including antiproliferative drug-eluting stents, has been a major breakthrough in invasive cardiology. Nowadays, a change in the clinical presentation of patients treated with percutaneous coronary intervention (PCI) is observed. The typical clinical characteristics now include advanced age, diabetes, chronic kidney disease, heart failure, and multilevel atherosclerosis. Age, diabetes, and chronic kidney disease are the main predictors of coronary artery calcifications. Severe coronary artery calcifications are the main factor limiting the efficacy of PCI. Successful stent implantation is challenging in the presence of calcifications, because it is difficult to achieve full stent expansion and proper stent apposition. Therefore, it is necessary to adequately prepare the lesion before stent implantation. This document presents the technique of rotational atherectomy (rotablation) as well as indications for and contraindications to the procedure, along with its possible complications and their prevention. Training in rotablation for operators as well as reimbursement policy for the procedure in Poland are also discussed.

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

Cited by 11 publications

References 21 publications

Stentablation as a Successful Treatment Strategy for Stent Underdeployment due to Calcified Plaque

Stentablation as a Successful Treatment Strategy for Stent Underdeployment due to Calcified Plaque

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

Rotational atherectomy in everyday clinical practice. Association of Cardiovascular Interventions of the Polish Society of Cardiology (Asocjacja Interwencji Sercowo-Naczyniowych Polskiego Towarzystwa Kardiologicznego — AISN PTK): Expert opinion

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