Abstract
Focal ultrashort balloons are essential tools for lesion preparation and final stent expansion. However, they may cause a major distortion of the adjacent segments. Here we report a case with a stent deformation emphasizing the importance of utilizing intravascular imaging techniques for optimal interventions.
A 53-year-old man with hypertension, smoking and diabetes developed exertional chest pain and underwent coronary angiography showing significant stenoses in the proximal and mid-LAD that were found alongside extensive calcification in the LAD. A 2.0 mm balloon did not expand forcing us to use a rotational atherectomy. After Rotablator, a 2.5 mm non-compliant balloon easily expanded, followed by a 2.75 × 32 mm Promus Premier Stent (Boston Scientific, MA, USA) and by post-dilatation with a 3.5 mm non-compliant balloon. The proximal lesion was covered with a 3.5 × 32 mm Promus Premier, overlapping with the first stent. After postdilatation, OCT showed good stent expansion and apposition in the distal stent and the overlap segment, but a focal lesion in the first 2 cm of the proximal stent required postdilatation with a 4.0 mm × 8 mm balloon (28 atm), starting a few millimetres proximal to the overlap. Postdilatation succeeded in apposing and expanding the proximal segment of the stent, but the distal segment had a localized distortion with severe malapposition, corrected with further dilatation ( Fig. 1 ).
