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CASE20191114_018
| CORONARY - Adjunctive Procedures (thrombectomy, atherectomy, special balloons) | |
| Stentablation as a Bail-Out for Severe Underexpansion of Stent Due to Circumferential Calcium | |
| N Prathap Kumar1, Blessvin Jino2 | |
| Meditrina Hospital, India1, Narayana Hrudhayalaya, India2, | |
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[Clinical Information]
- Patient initials or identifier number:
xon
-Relevant clinical history and physical exam:
•Patient is a 63 years old gentleman,smoker, no underlying co-morbidities, presented with the complaints of chestpain which lasted for 10-15 minutes. •No orthopnea/PND. •EKG: SR, ST depression (1mm) with T WaveInversion in V4-V6, I, aVL. •Echocardiogram: No obvious RWMA.Concentric LVH.EF-50% -Relevant test results prior to catheterization:
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
•LMCA was engaged with 6f LeftEBU3.5coronary guide catheter•LAD was crossed with Fielder FC guidewireand predilated with 1.5x15mm Maverik¢â followed by 2.5x15mm NC Quantum Apex.•Lesion looked adequately prepared andresidual lesion was stented from ostio proximal to mid LAD with 3.5x38mm XIENCEXpedition DES, deployed at 11 ATM•We can see a dumbbell shapedunder-expansion in the middle of the stent.•Under-expanded segment was post dilatedwith 2.75x8mm and 3x8mm NC Quantum Apex¢â balloon however, it didn¡¯t yield.•Hence guidewire was exchanged to 0.009¡±Rotawire and rota-ablation was done with 1.5mm Rotalink¢â plus bar at 160,000rpmfor 10second x 4 runs, just trying to cause crack in the calcium and not beingaggressive in pushing the burr distally.•Postdilated with 3x8mm NC Quantum Apex,but lesion didn¡¯t give way and againwith3.5x8mm NC Quantum Apex¢â balloon, thelesion gave away.•Mid to distal LAD was then stented with3x48mm XIENCE Xpedition DES, overlapping the distal edge of previous stent.Distal LAD lesion was then predilated with 2.5x15mm NC Quantum Apex.Distal LADresidual lesion was stented with 2.5x23mm XIENCE Xpedition DES, deployed at11atm. TIMI III flow achieved.  VideoJoiner191114220422.avi VideoJoiner191114220513.avi- Case Summary:
•Coronary stent implantation in severelycalcified lesions without adequate lesion preparation may result in-stentunder-expansion, thus potentially leading to stent thrombosis and restenosis. •Even though Rotational Atherectomy(RA)after deploying a stent is not an ideal choice, since the damage to the stentstruts may result in acute complications and the long term results are unknown,this case indicated that RA could be a useful remedy in the situation ofunder-expansion of implanted stents. •We feel when stentablation is donecarefully, the benefits outweigh the risks. |
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