title: Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report.
abstract: Heavy coronary artery calcification is responsible for stent underexpansion, which is associated with increased in-stent restenosis. Here we report a case in which optical coherence tomography (OCT) demonstrated that the metal component of an underexpanded stent previously implanted in a heavy calcified lesion had been completely removed after ablation with rotational atherectomy.
  
  
  
  An 83-year-old man with exertional angina was referred to our hospital. Coronary angiography revealed severe stenosis in the proximal portion of the right coronary artery and left circumflex artery and chronic total occlusion (CTO) in the mid portion of the left anterior descending artery (LAD). We performed complete revascularization with percutaneous coronary intervention. Because the CTO lesion in LAD contained napkin-ring heavy calcifications, rotational atherectomy with a 1.75-mm burr was undergone, followed by the deployment of drug-eluting stents and postdilation with a high-pressure balloon. However, expansion of the stent was incomplete. To address the recurrence of in-stent restenosis and resistance to the dilation with the high-pressure balloon, we decided to simultaneously ablate both the heavy calcification and underexpanded stent. Longitudinal stent ablation with 1.75- and 2.0-mm burrs was successful, and OCT demonstrated that the metallic component of the underexpanded stent had been completely removed.
  
  
  
  If a stent fails to completely extend in heavy calcification, longitudinal stent ablation by rotational atherectomy could be an effective remedy.
authors.affiliation: Department of Cardiovascular Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho, Kamigyoku, Kyoto, 602-8026, Japan. koide@koto.kpu-m.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Koide
authors.affiliation: Department of Cardiovascular Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho, Kamigyoku, Kyoto, 602-8026, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Cardiovascular Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho, Kamigyoku, Kyoto, 602-8026, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsuo
authors.affiliation: Department of Cardiovascular Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho, Kamigyoku, Kyoto, 602-8026, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
mesh_terms: D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000379:methods*; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Case report; Coronary angiography; Optical coherence tomography; Percutaneous coronary intervention; Rotational atherectomy