Author + information
- Tomohiro Yamasaki1
We have occasionally encountered restenosis due to the crushing of drug-eluting stent (DES) implanted in severely calcified lesions. In such cases, it is difficult to prevent recurrent restenosis with additional balloon angioplasty or implanting of another DES because the severely calcified lesions will crush the stent again. The aim of this study is to evaluate the efficacy of rotational atherectomy to treat in-stent restenosis lesions.
In patients who were suffered from repetitive in-stent restenosis, rotational atherectomy was performed to ablate the crushed stent struts and the calcified plaques behind them. Then new DES was implanted in these lesions. We measured these; minimum lumen area (MLA), minimum lumen diameter (MLD), minimum stent area (MSA) and minimum stent diameter (MSD) by using intravascular ultrasonography (IVUS) before and after percutaneous coronary intervention (PCI).
We experienced ablation of the crushed stent struts and the calcified plaques behind them in 9 cases who were suffered from repetitive in-stent restenosis because of the original calcified plaque. Table 1 summarizes the baseline patient and lesion demographics and Table 2 summarizes the procedural results in detail. It was accomplished good stent expansion in the cross-sectional IVUS images. MSA was significantly bigger than MLA (2.89 ± 0.65 mm2 vs 7.78 ± 1.28 mm2; P=0.0004). However, there was not a significant difference in MSD and MLD (2.74 ± 0.44 mm vs 1.64 ± 0.21 mm; P=0.84). This comparison is shown in Figure 1.
Rotational atherectomy might be a safe and promising option for the treatment of restenosis lesions caused by the crushing of DES in severely calcified lesions.