Investigation of the Efficacy of Rotational Atherectomy for Stent Deformation with Calcified Plaques

Objectives: This study aimed to investigate the effectiveness of rotational atherectomy for the treatment of stent deformation with calcified plaques.Background: A suitable treatment for stent deformation due to severe calcification has not yet been established for percutaneous coronary intervention (PCI).Stent ablation using rotational atherectomy is one option, but very few cases have been reported, and a standard methodology has not yet been established. Methods:The study population consisted of 13 consecutive patients with angina pectoris due to stent deformation caused by severe calcification, treated between December 2010 and December 2023.Rotational atherectomy was performed to ablate the deformed stent struts and the underlying calcified plaques.Balloon angioplasty, followed by additional stent implantation or drug-coated balloon (DCB) dilatation, was performed.Results: In the acute phase, an angiographic quantitative coronary analysis and cross-sectional intravascular ultrasound (IVUS) image analysis showed good expansion (minimum lumen diameter [MLD]: 0.9 0.4 mm to 3.0 0.5 mm, P < 0.0001; minimum stent area [MSA]: 2.5 0.8 mm 2 to 7.5 1.4 mm 2 , P < 0.0001).In the late clinical phase, a quantitative coronary analysis after the procedure was not significantly different from that at follow-up in MLD on coronary angiography (CAG) (MLD: 3.0 0.5 mm and 2.6 0.5 mm, respectively, P = 0.0851).The restenotic stent had a near-circular morphology in the group compared to the group without burr entrapment (symmetry index: 0.7 0.1, 0.9 0.1, P = 0.0013).Conclusions: Rotational atherectomy may be effective in the treatment of stent restenosis due to stent deformation with calcified plaques.