Case Report: To Stop on Time – One of the Hardest Decisions: ‘Loss’ of the Stent in a Calcified RCA

Abstract

A case report of a 63-year-old man who was indicated for invasive coronarography during outpatient treatment. The completed coronarography confirmed a significant stenosis in the highly calcified right coronary artery (RCA). In order to determine the hemodynamic significance of the borderline significant stenosis of the curved branch of the left coronary artery, FFR was performed. Despite the use of non-compliance balloons and high-pressure OPN balloons during elective PCI-RCA, the lesion in question could not be predilated, resulting in the need for the patient to undergo PCI-RCA with rotablation. During the repeated PCI-RCA procedure, the proximal and middle segments were subjected to rotablation. Non-compliant balloon catheters were used to perform a successful predilatation of the middle segment lesion and to try to place a stent in the designated lesion. Due to the calcified curve of the proximal segment, the stent was unable to pass through while being retracted into the leading catheter, causing it to fall into the proximal segment. The stent balloon was used to push the stent and insert it into the curve between the proximal and middle segment. A small balloon catheter (1.2 x 15 mm) successfully passed through the unexpanded stent. After subsequent inflating of the small balloon catheter and further inflating of larger balloons the lost stent was fully expanded and implanted with optimal control coronarography findings.

Keywords

• Coronary artery calcification
• Rotablation
• High-pressure OPN balloon