PMC3296494_01
Coronary angiography reveals a 90% stenosis of the right coronary artery (RCA) (A). Direct stenting of the bare metal stent (BMS) results in an underexpansion (B) and residual stenosis in the mid-part (C).
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Coronary angiography, which was performed via right radial access using a 5F sheath, revealed a 50% stenosis of the left anterior descending artery (LAD) and ramus posterolateralis sinistra (RPLS) while the right coronary artery (RCA) had a critical 90% stenosis (Fig. 1A). B. Braun, Melsungen, Germany) with 18 atm for 30 sec (Fig. 1B). Post-PCI angiography revealed a 75% stenosis in the mid-portion of the stent (Fig. 1C).
Rotational atherectomy of the remaining calcified stenosis within the stent and the underexpanded stent struts (stentablation) (A) with acceptable result in the following angiography. Drug-eluting stent (DES) implantation (rotastenting) (B) after rotational atheterctomy without any evidence for residual stenosis in final angiogram (C). Coronary angiography performed 6 months after index-PCI revealed a mild (25%-50%) restenosis (D).
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After passing across the stenosis with the 0.009 rotawire we ablade the heavily calcified stenosis as well as the stent struts (stentablation) (Fig. 2A). With complete expansion of the balloons the procedure was continued with implantation of a drug-eluting stent (Taxus Liberte 4.0/12 mm [Boston Scientific, Natick, USA] with 16 atm over 30 sec) (rotastenting) (Fig. 2B). Finally, there was TIMI 3 without evidence of dissection or residual stenosis (Fig. 2C). A routine coronary angiography performed 6 months after index-PCI revealed a good result with a mild (25%) restenosis (Fig. 2D).