Stent Ablation by Rotational Atherectomy for Management of Resistant Lesions within and across the Stent Struts in Coronary Arteries

Abstract

Background: Non-dilatable stent underexpansion has limited treatment options. Stent ablation by rotational atherectomy (RA) for the management of non-dilatable coronary stents is an off-label strategy. The principle of stent ablation by RA of underexpanded stent relies on modification of both stent and underlying calcium. This study aims to describe and compare the use of RA for non-dilatable lesions in two anatomical categories: group 1 (within the stent struts) and group 2 (across the stent struts). Methods: A total of seven patients who had undergone stent ablation by RA were analysed. Indications for revascularisation were acute coronary syndrome or chronic stable angina. Two groups are described: RA within underexpanded stents (group 1) and across the stent struts (across stented bifurcation; group 2). Results: The burr:artery ratio was 0.6 ± 0.1 in group 1 and 0.5 in group 2 (p=0.24). The maximum rotational speed was 154,400 ± 2,500 and 155,000 rpm in the two groups. The total number of RA runs was 3.6 ± 0.90 in group 1 and 7.0 ± 2.8 in group 2, respectively, p=0.04. Procedural success was achieved in all cases with no complications. Conclusion: RA is a feasible bailout option for resistant non-dilatable lesions within and across the stent struts.