Escape from True Stent Jail by Use of the Rotablator
We describe the use of the Rotablator device to allow sidebranch access via the side-wall of a stent when it has proved impossible to pass even the lowest profile balloon catheter through the struts -- a situation of "true stent jail".
Although coronary artery stenting has led to a reduction in acute complications and late restenosis after percutaneous transluminal coronary angioplasty (PTCA), stenosis or occlusion of sidebranches which exit the stented area may result. This phenomenon may occur acutely due to plaque shift or within the first six months after the procedure due to the fibrointimal hyperplasia induced by stent implantation. The sidebranch is then said to be in "stent jail". It is probably more likely to occur with stents with a high metal-to-artery ratio, e.g., the Wallstent, or where overlapping stents cover a side branch. If necessary, it may be possible to enter the affected sidebranch via the side-wall of the stent with a guidewire and a low-profile balloon catheter in order to perform PTCA and even stent implantation; however, this is not always possible, especially if a stent strut lies directly across the ostium of the stenosed branch vessel.
These two case reports describe the use of the Rotablator device (Boston Scientific/Scimed, Maple Grove, Minnesota) to allow sidebranch access via the side-wall of a stent when it has proved impossible to pass even the lowest profile balloon catheter through the struts -- a situation of "true stent jail".
We describe the use of the Rotablator device to allow sidebranch access via the side-wall of a stent when it has proved impossible to pass even the lowest profile balloon catheter through the struts -- a situation of "true stent jail".
Although coronary artery stenting has led to a reduction in acute complications and late restenosis after percutaneous transluminal coronary angioplasty (PTCA), stenosis or occlusion of sidebranches which exit the stented area may result. This phenomenon may occur acutely due to plaque shift or within the first six months after the procedure due to the fibrointimal hyperplasia induced by stent implantation. The sidebranch is then said to be in "stent jail". It is probably more likely to occur with stents with a high metal-to-artery ratio, e.g., the Wallstent, or where overlapping stents cover a side branch. If necessary, it may be possible to enter the affected sidebranch via the side-wall of the stent with a guidewire and a low-profile balloon catheter in order to perform PTCA and even stent implantation; however, this is not always possible, especially if a stent strut lies directly across the ostium of the stenosed branch vessel.
These two case reports describe the use of the Rotablator device (Boston Scientific/Scimed, Maple Grove, Minnesota) to allow sidebranch access via the side-wall of a stent when it has proved impossible to pass even the lowest profile balloon catheter through the struts -- a situation of "true stent jail".
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