Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions

Luca Ferri, RJ Jabbour, Francesco Giannini, S Benincasa, M Ancona, D Regazzoli, A Mangieri, M Montorfano, A Colombo, A Latib

Research output: Contribution to journalArticle

Abstract

Objectives: Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once noncompliant balloons have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection is one possibility, but not readily available. Rotational atherectomy is an alternative, and has been described in case reports, but concerns exist regarding safety. Methods: All consecutive patients undergoing rotational atherectomy for symptomatic in-stent restenosis due to stent underexpansion resistant to noncompliant balloon postdilatation between January 2005 and December 2015 were analysed. Results: A total of 16 patients underwent treatment during the study period and the procedure was successful in 14 cases (87.5%). The mean postprocedural minimal lumen diameter increased by 2.3±0.8 mm and percentage diameter stenosis decreased from 82.17%±17.2% to 11.9%±9.1%. Intraprocedural complications occurred in two patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3% (2 out of 15 patients), and one patient died from noncardiac death. Conclusion: In this small series of underexpanded stents, rotational atherectomy was an effective treatment for resistant stent underexpansion with acceptable outcomes. © 2016 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)E19–E24
JournalCatheterization and Cardiovascular Interventions
Volume90
Issue number2
DOIs
Publication statusPublished - 2017

Fingerprint

Coronary Atherectomy
Stents
Safety
Therapeutics
Laser Angioplasty
Excimer Lasers
Contrast Media
Pathologic Constriction
Thrombosis
Myocardial Infarction
Injections

Cite this

Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions. / Ferri, Luca; Jabbour, RJ; Giannini, Francesco; Benincasa, S; Ancona, M; Regazzoli, D; Mangieri, A; Montorfano, M; Colombo, A; Latib, A.

In: Catheterization and Cardiovascular Interventions, Vol. 90, No. 2, 2017, p. E19–E24.

Research output: Contribution to journalArticle

Ferri, L, Jabbour, RJ, Giannini, F, Benincasa, S, Ancona, M, Regazzoli, D, Mangieri, A, Montorfano, M, Colombo, A & Latib, A 2017, 'Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions', Catheterization and Cardiovascular Interventions, vol. 90, no. 2, pp. E19–E24. https://doi.org/10.1002/ccd.26836
Ferri, Luca ; Jabbour, RJ ; Giannini, Francesco ; Benincasa, S ; Ancona, M ; Regazzoli, D ; Mangieri, A ; Montorfano, M ; Colombo, A ; Latib, A. / Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 90, No. 2. pp. E19–E24.
@article{ba21a8706471491bac452e2eaeb34b3d,
title = "Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions",
abstract = "Objectives: Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once noncompliant balloons have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection is one possibility, but not readily available. Rotational atherectomy is an alternative, and has been described in case reports, but concerns exist regarding safety. Methods: All consecutive patients undergoing rotational atherectomy for symptomatic in-stent restenosis due to stent underexpansion resistant to noncompliant balloon postdilatation between January 2005 and December 2015 were analysed. Results: A total of 16 patients underwent treatment during the study period and the procedure was successful in 14 cases (87.5{\%}). The mean postprocedural minimal lumen diameter increased by 2.3±0.8 mm and percentage diameter stenosis decreased from 82.17{\%}±17.2{\%} to 11.9{\%}±9.1{\%}. Intraprocedural complications occurred in two patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3{\%} (2 out of 15 patients), and one patient died from noncardiac death. Conclusion: In this small series of underexpanded stents, rotational atherectomy was an effective treatment for resistant stent underexpansion with acceptable outcomes. {\circledC} 2016 Wiley Periodicals, Inc.",
author = "Luca Ferri and RJ Jabbour and Francesco Giannini and S Benincasa and M Ancona and D Regazzoli and A Mangieri and M Montorfano and A Colombo and A Latib",
year = "2017",
doi = "10.1002/ccd.26836",
language = "English",
volume = "90",
pages = "E19–E24",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions

AU - Ferri, Luca

AU - Jabbour, RJ

AU - Giannini, Francesco

AU - Benincasa, S

AU - Ancona, M

AU - Regazzoli, D

AU - Mangieri, A

AU - Montorfano, M

AU - Colombo, A

AU - Latib, A

PY - 2017

Y1 - 2017

N2 - Objectives: Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once noncompliant balloons have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection is one possibility, but not readily available. Rotational atherectomy is an alternative, and has been described in case reports, but concerns exist regarding safety. Methods: All consecutive patients undergoing rotational atherectomy for symptomatic in-stent restenosis due to stent underexpansion resistant to noncompliant balloon postdilatation between January 2005 and December 2015 were analysed. Results: A total of 16 patients underwent treatment during the study period and the procedure was successful in 14 cases (87.5%). The mean postprocedural minimal lumen diameter increased by 2.3±0.8 mm and percentage diameter stenosis decreased from 82.17%±17.2% to 11.9%±9.1%. Intraprocedural complications occurred in two patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3% (2 out of 15 patients), and one patient died from noncardiac death. Conclusion: In this small series of underexpanded stents, rotational atherectomy was an effective treatment for resistant stent underexpansion with acceptable outcomes. © 2016 Wiley Periodicals, Inc.

AB - Objectives: Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once noncompliant balloons have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection is one possibility, but not readily available. Rotational atherectomy is an alternative, and has been described in case reports, but concerns exist regarding safety. Methods: All consecutive patients undergoing rotational atherectomy for symptomatic in-stent restenosis due to stent underexpansion resistant to noncompliant balloon postdilatation between January 2005 and December 2015 were analysed. Results: A total of 16 patients underwent treatment during the study period and the procedure was successful in 14 cases (87.5%). The mean postprocedural minimal lumen diameter increased by 2.3±0.8 mm and percentage diameter stenosis decreased from 82.17%±17.2% to 11.9%±9.1%. Intraprocedural complications occurred in two patients (burr entrapment successfully managed percutaneously and periprocedural myocardial infarction). At 1-year follow-up, the incidence of target lesion revascularisation was 13.3% (2 out of 15 patients), and one patient died from noncardiac death. Conclusion: In this small series of underexpanded stents, rotational atherectomy was an effective treatment for resistant stent underexpansion with acceptable outcomes. © 2016 Wiley Periodicals, Inc.

U2 - 10.1002/ccd.26836

DO - 10.1002/ccd.26836

M3 - Article

VL - 90

SP - E19–E24

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 2

ER -