Key result
Rotational atherectomy through triple-layer in-stent restenosis causes coronary perforation after failed balloon and lithotripsy attempts.
Case Report (n=1)
This case report describes a complex percutaneous coronary intervention in an 82-year-old man with 3 overlapping stent layers in the first obtuse marginal artery complicated by sustained ventricular tachycardia during lithotripsy delivery and perforation from rotational atherectomy.
Undilatable multilayered stent restenosis warrants caution with lithotripsy; leaves open safer debulking strategies for complex lesions.
An 82-year-old man with 2 prior bypass operations presented with non-ST-segment elevation myocardial infarction. The first obtuse marginal (OM1) carried 3 overlapping stent layers implanted in 1995, 1996, and 2010, spanning 2 stent eras: the first 2 bare-metal, the third drug-eluting; device records for the earlier layers were unavailable. Noncompliant and scoring balloons crossed but would not expand the restenosis; sustained ventricular tachycardia during lithotripsy balloon delivery aborted the procedure.
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Damera et al. (2026) conducted a case report in Non-ST-segment elevation myocardial infarction and in-stent restenosis across 3 overlapping stent layers (n=1). Rotational atherectomy, noncompliant/scoring balloons, and intravascular lithotripsy was evaluated on Stent expansion and procedural complication (perforation and sustained ventricular tachycardia). Rotational atherectomy through 3 overlapping stent layers in an 82-year-old man caused perforation after noncompliant/scoring balloons failed to expand and lithotripsy triggered sustained VT.
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