Slides Coronary Others
Rotablating Atherectomy for Treatment of Unexpanded Stent at Heavily Calcified Lesion
- Operator : Seung-Jung Park
Rotablating Atherectomy for Treatment of Unexpanded Stent at Heavily Calcified Lesion |
- Operator: Seung-Jung Park, MD |
Patient presentation |
A 55 year old man was admitted with effort angina for 3 months. He had diabetes mellitus and hypertension for coronary risk factors. Baseline coronary angiogram (CAG) showed three-vessel disease. After stenting in the left anterior descending and circumflex arteries with Cypher stents, we tackled the proximal right coronary artery (RCA) lesion. |
Procedure |
Right coronary ostium was engaged with an 8Fr
AL2 guiding catheter. The CAG showed diffuse calcified narrowing of the
proximal RCA (Image
1). The lesion was predilated with a Black-Hawk balloon
(2.5 x 20 mm). Fluoroscopic indentation at the center of balloon was
not relieved at 20 atm (Image
2). In spite of the residual indentation,
we intended to put a stent because the lesion did not look serious. So,
a Cypher stent (3.5 x 28 mm) was deployed at the lesion (Image
3), but
unexpanded (Image
4). We tried repeated high pressure balloon dilatations
with a non-compliant Quantum balloon (2.5 x 8 mm) up to 30 atm (Image
5). However, the stent was not dilated due to the heavy calcification
(Image
6). Therefore, we performed rotablating atherectomy as a rescue
procedure using 1.5 and 2.5 mm burrs (Image
7). Following angiogram showed
slightly widened lumen (Image
8). IVUS showed discontinuation of the
grinded stent strut ( |
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