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Case 9: A case of stent underexpansion treated with ELCA

Case Presentation

75-year-old male presented with new onset CCS class III angina to our hospital. Patient has history of hypertension, IDDM, hyperlipidemia and has had multiple PCI procedures. Most recently, 5 months ago, DES were implanted mid LAD (2.5x38mm, 2.75x18mm) at outside hospital. Echocardiography showed good left ventricular systolic function (Ejection Fraction of 65%). A coronary angiogram showed 80-90% stenosis of the mid LAD.

Angio Pre

Coronary angiography showed a highly underexpanded stent that could be seen without contrast in the mid LAD. We attempted to confirm the lesion with IVUS, but it was difficult to cross the lesion due to the high degree of stenosis. As far as we could see, the stent was underexpanded and there was severe calcification outside the stent.

IVUS Pre; couldn’t cross the lesion

Therefore, we performed dilatation with a 2.0mm non-compliant (NC) balloon and performed ELCA with contrast medium. Then, the balloon size was increased step by step, and after dilation with a 2.5mm balloon, IVUS showed disruptions in the calcification behind the stent. Seeing the calcium modifications, we dilated the lesion with 3.5mm NC balloon up to 14atm pressure and completed the PCI.

Angio Post

IVUS Post

Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. In this case, after ELCA, we were able to confirm the disruptions of calcified plaque beneath the stent strut by IVUS, and additional non-compliant balloon dilatation was effective in expanding the underexpanded segment of the prior stent.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

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