Rotational atherectomy (RA) has been described in case reports to be effective in ablating under-expanded
stents. We present a case of calcified bifurcation lesion
percutaneous coronary intervention (PCI), in which the branch
stent protruding into main branch blocked the balloon getting through, and the following RA led to
pericardial tamponade. The first
stent was deployed from the proximal of left anterior descending artery (LAD) to the proximal of diagonal for an 80-year-old man who suffered from
non-ST-elevation myocardial infarction to make a Culotte dual
stent PCI. The operator failed to make balloon get through the struts protruding into LAD lumen anyway. After RA drill through the LAD lumen, it showed an excellent angiographic outcome.
Stent deployment in LAD was successful, but
pericardial tamponade occurred in a short time. After pericardiocentesis was performed under fluoroscopic guidance, the patient was uneventful. After 1 year, the follow-up coronary computed tomography (CT) angiography showed no in-
stent restenosis,
stent fracture or disrupted struts protruding outside of the vessel's outline of LAD and the first diagonal (D1). This case shows
stents' RA could be dangerous in grinding across the
stents' lateral hole in an unsymmetrical lumen. Although RA could be a useful remedy in the situation of under-expansion of implanted
stents, the debulking should be performed for longitudinal
stent ablation and cautiously performed for bifurcation lesion in which the protruding
stents from side branch were unsymmetrically blocking the path.