Key result
Scoring balloon predilatation followed by stenting for calcified in-stent restenosis resulted in stent underexpansion due to unyielding neointimal calcification.
Case Report (n=1)
This case highlights the critical need to confirm adequate lesion preparation with imaging such as OCT before deploying a new stent in patients with calcified in-stent restenosis.
May warrant OCT confirmation of preparation before stenting calcified ISR; leaves open optimal techniques.
A 74-year old man presented recurrent angina pectoris due to in-stent restenosis (ISR) with severely calcified neointima. In-stent neoatherosclerosis (NA) is associated with late stent failure, and NA with calcified neointima occurs in some cases. Because the presence of neointimal calcification could lead to underexpansion of newly implanted stent for ISR, a scoring balloon was selected for predilatation to obtain maximum extrusion of the neointimal plaque and subsequently, an everolimus-eluting stent was implanted. However, moderate stenosis remained on coronary angiography, and optical coherence tomography (OCT) revealed underexpansion of the newly implanted stent because an attempt at balloon dilatation of neointimal calcification failed. Although OCT can clearly discriminate stent struts from neointimal calcification, we did not perform OCT assessment between scoring balloon and stenting. It is highly recommended to confirm whether the lesion is adequately treated by balloon angioplasty before stenting in cases with calcified ISR.
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Kashiwagi et al. (2018) conducted a case report in Recurrent angina pectoris due to in-stent restenosis with severely calcified neointima (n=1). Scoring balloon predilatation and everolimus-eluting stent implantation was evaluated. Scoring balloon predilatation followed by stenting for calcified in-stent restenosis resulted in stent underexpansion due to unyielding neointimal calcification.
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