Journal of Invasive Cardiology

Rotational Atherectomy is Useful to Treat Restenosis Lesions due to Crushing of a Sirolimus-Eluting Stent Implanted in Severely Calcified Lesions: Experimental Study and Initial Clinical Experience

From the Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted February 17, 2009, provisional acceptance given June 9, 2009, and final version accepted June 12, 2009.

Address for correspondence: Hiroshi Ito, MD, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan. E-mail: itomd@osk4.3web.ne.jp

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ABSTRACT: We have occasionally encountered restenosis due to the crushing of drug-eluting stents (DES) implanted in severely calcified lesions. We aimed to establish the role of rotational atherectomy (RA) in its treatment. At first, we conducted an experimental study and found that the size of the metallic particles generated during RA of stent struts was 5.6 ± 3.6 µm. We performed RA on the restenosis of the sirolimus-eluting stents implanted in the severely calcified lesions of a 66-year-old male who had received hemodialysis for 13 years. He had restenosis in the proximal and mid-segments of the right coronary artery, and intravascular ultrasound images documented that these stents were crushed by calcified plaque behind them. RA ablated both crushed stent struts and the calcified lesions behind them, and there was no hemodynamic derangement during the procedure. Maximum dilatation of the lesions was achieved with balloon angioplasty, followed by stent implantation. RA is an effective strategy to treat restenotic lesions resulting from the crushing of DES in severely calcified lesions.

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J INVASIVE CARDIOL 2009;21e191–E196

Drug-eluting stents (DES) inhibit neointimal hyperplasia and reduce the rates of restenosis and target vessel revascularization.^1,2 There is increasing interest in the technical and mechanical reasons for restenosis after DES implantation including balloon injury at the stent edges,³ stent underexpansion, stent fracture,^4,5 and so forth. We often experience restenosis caused by the crushing of DES implanted in severely calcified lesions. In such cases, it is difficult to prevent recurrent restenosis with additional balloon angioplasty or implantation of another DES because the severely calcified lesion will crush the stent again.

We first studied the number and size of the particles generated during rotational atherectomy (RA) for stent struts in the experimental model. We applied RA to ablate crushed stent struts and the calcified plaques behind them for recurrent restenosis in a patient.