Combination of Laser Atherectomy and Super High-pressure Non-compliant Balloon to Treat Stent Under-expansion in Cases of Failed Interventional Options

Abstract

Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain. The authors report on a patient with prior numerous right coronary unsuccessful coronary interventions resulting in partially crushed multiple layers of stent material with critical lumen narrowing caused by stent under-expansion. Balloon angioplasty and stent rotational atherectomy (ROTA) had been attempted to overcome stent under-expansion but were unsuccessful. The authors investigated a new combination therapy of laser atherectomy (ELCA) and super high-pressure balloon (OPN non-compliant balloon) to treat single or multiple layers of stent with severe under-expansion due to fibrotic, calcified tissue surrounding the under-expanded stent structure.

Keywords: Percutaneous coronary intervention; balloon angioplasty; crushed stent; laser coronary atherectomy; rotational atherectomy; stent under-expansion.

Figure 1:. Diagnostic Angiographic and Optical Coherence Tomography Images of Under-expanded Stented Right Coronary Artery Segment and Failure of Conventional Balloon Angioplasty

Figure 2:. Angiographic and Optical Coherence Tomography Images of Laser, Super High-pressure Non-compliant Balloon Successful Treatment