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Successful optical coherence tomography-guided stent ablation with rotational atherectomy for an underexpanded stent

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Address for correspondence: Deok-Kyu Cho, MD, Cardiovascular Center, Yongin Severance Hospital, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin 16995, Korea, tel: 82-31-5189-8755, fax: 82-31-5189-8567, e-mail: chodk123@yuhs.ac

Received: 5.06.2020 Accepted: 5.06.2020

Successful optical coherence tomography-guided stent ablation with rotational atherectomy

for an underexpanded stent

Yongcheol Kim , Deok-Kyu Cho , Ji Woong Roh , Oh-Hyun Lee , Eui Im , Donghoon Choi

Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea

A 62-year-old man with a history of ischemic heart disease and dyslipidemia presented with aggravating effort angina. He underwent stent implantation with a 3.0 × 40 mm sirolimus-eluting stent at the mid portion of left anterior descending artery 2 years prior, but a heavily calcified lesion led to severe stent underexpansion, which did not resolve despite postdilation with a non-compliant (NC) balloon (Suppl. Video 1). Angiography dem- onstrated aggravated luminal narrowing in the un- derexpanded stent site (Fig. 1A, Suppl. Video 2);

therefore, stent ablation with rotational atherec- tomy was planned. Pre-interventional optical co- herence tomography (OCT) demonstrated that the diameter of the underexpanded stent was between 1.24 and 1.66 mm (Fig. 1B, C, Suppl. Video 3), which was also confirmed on three-dimensional OCT (Fig. 1D). OCT assessment led to stent abla- tion using a stepwise increase in burr size, from

1.25 mm to 1.50 mm and finally 1.75 mm. Following stent ablation, OCT showed no visible strut area in the site of the previously underexpanded stent (Fig. 1E, F). However, a minimal lumen area of 2.27 mm2 led to the performance of drug-coated balloon angioplasty with a 3.0 × 20 mm Pantera Lux (Biotronik, Bülach, Switzerland) after balloon dilation with a 3.0 × 15 mm NC balloon at 24 atm.

Final angiography showed good distal flow without residual stenosis (Fig. 1G, Suppl. Video 4).

This report highlights the superior resolution of OCT, which can aid in choosing the optimal burr size, and presents OCT images of successful stent ablation.

Acknowledgements

The authors would like to thank all the staff, especially Dae Seok Jang, working in the cardiac catheterization laboratories at Yongin Severance Hospital for their commitment to this study.

Conflict of interest: None declared

897 www.cardiologyjournal.org

INTERvENTIONAL CARDIOLOGY

Cardiology Journal 2020, Vol. 27, No. 6, 897–898

DOI: 10.5603/CJ.2020.0173 Copyright © 2020 Via Medica

ISSN 1897–5593 eISSN 1898–018X

IMAGE IN CARDIOVASCULAR MEDICINE

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Figure 1. A. Initial angiography demonstrating underexpanded stent (white box); B, C. Cross-sectional optical coher- ence tomography (OCT) imaging of underexpanded stent site; D. Three-dimensional OCT reconstructed strut image of underexpanded stent site; E, F. OCT demonstrating no visible struts after stent ablation with rotational atherectomy;

G. Final angiography demonstrating no residual stenosis after treatment with 3.0 × 20 mm drug-coated balloon.

898 www.cardiologyjournal.org

Cardiology Journal 2020, Vol. 27, No. 6

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