Cutting Balloon Angioplasty for Underexpanded Stent
We describe a case in which stenting through the struts of a previously deployed stent resulted in stent underexpansion despite 25 atm inflation pressure. Four months later, follow-up angiography demonstrated in-stent restenosis. It was successfully expanded with a Cutting Balloon.
Since randomized studies showed a lower restenosis rate in focal coronary artery lesions with coronary stenting compared to conventional balloon angioplasty, indications for stenting expanded to complex lesions such as bifurcation and ostial lesions. When stenting a bifurcation, a stent may cover the ostium of the branch. Balloon inflation through stent struts may sometimes be necessary in order to treat a compromised sidebranch or a new lesion at the ostium during follow-up. However, stent struts may prevent full balloon expansion at the ostium of a sidebranch, resulting in residual ostial stenosis, which is a risk of restenosis.
The Cutting Balloon (Interventional Technologies, San Diego, California) has been used to treat resistant lesions and in-stent restenosis. This balloon catheter has 3-4 microblades longitudinally attached to the balloon, which create a focused force to dilate a resistant lesion. This case report describes Cutting Balloon angioplasty for an underexpanded stent deployed through the struts of a previously implanted stent.
We describe a case in which stenting through the struts of a previously deployed stent resulted in stent underexpansion despite 25 atm inflation pressure. Four months later, follow-up angiography demonstrated in-stent restenosis. It was successfully expanded with a Cutting Balloon.
Since randomized studies showed a lower restenosis rate in focal coronary artery lesions with coronary stenting compared to conventional balloon angioplasty, indications for stenting expanded to complex lesions such as bifurcation and ostial lesions. When stenting a bifurcation, a stent may cover the ostium of the branch. Balloon inflation through stent struts may sometimes be necessary in order to treat a compromised sidebranch or a new lesion at the ostium during follow-up. However, stent struts may prevent full balloon expansion at the ostium of a sidebranch, resulting in residual ostial stenosis, which is a risk of restenosis.
The Cutting Balloon (Interventional Technologies, San Diego, California) has been used to treat resistant lesions and in-stent restenosis. This balloon catheter has 3-4 microblades longitudinally attached to the balloon, which create a focused force to dilate a resistant lesion. This case report describes Cutting Balloon angioplasty for an underexpanded stent deployed through the struts of a previously implanted stent.
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