Koide Masahiro, Inoue Keiji, Matsuo Akiko, Fujita Hiroshi
Department of Cardiovascular Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho, Kamigyoku, Kyoto, 602-8026, Japan.
BMC Cardiovasc Disord. 2016 Nov 29;16(1):241. doi: 10.1186/s12872-016-0419-8.
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.
严重的冠状动脉钙化会导致支架扩张不全，这与支架内再狭窄增加有关。在此，我们报告一例病例，光学相干断层扫描（OCT）显示，先前植入重度钙化病变处的扩张不全支架的金属成分在旋磨消融后已被完全清除。
一名83岁劳力性心绞痛男性患者被转诊至我院。冠状动脉造影显示右冠状动脉近端和左旋支严重狭窄，左前降支（LAD）中段慢性完全闭塞（CTO）。我们通过经皮冠状动脉介入治疗实现了完全血运重建。由于LAD的CTO病变包含餐巾环样重度钙化，因此使用1.75毫米的磨头进行了旋磨治疗，随后植入药物洗脱支架并使用高压球囊进行后扩张。然而，支架扩张不完全。为解决支架内再狭窄复发以及对高压球囊扩张的抵抗问题，我们决定同时消融重度钙化和扩张不全的支架。使用1.75毫米和2.0毫米的磨头进行纵向支架消融成功，OCT显示扩张不全支架的金属成分已被完全清除。
如果支架在重度钙化中未能完全展开，通过旋磨进行纵向支架消融可能是一种有效的补救措施。
