Long‐term outcomes of rotational atherectomy of underexpanded stents. A single center experience

OBJECTIVES: To analyze the procedural and long‐term outcomes of the use of rotational atherectomy (RA) in underexpanded stents in our cohort and to provide an overview of currently available data on this technique. BACKGROUND: Stent underexpansion (SU) has been related to stent thrombosis and restenosis. RA has been used to treat undilatable SU as a bail‐out strategy with encouraging results. METHODS: This is an observational, single‐center study. We included patients who underwent stentablation between 2013 and 2017. Baseline demographics, procedural results, in‐hospital major adverse cardiac events (MACE), and long‐term follow‐up MACE were retrospectively collected. RESULTS: A total of 11 patients (90.9% males, mean age 65.4 ± 18.6) were included in this study. Median left ventricle ejection fraction was 53.5% [46.2‐55]. Median calculated Syntax score was 16 [9‐31] and 45.5% of patients were admitted for acute coronary syndrome. Radial approach was used in 63.6% of cases. Most patients only required one burr (45% used a 1.5 mm diameter burr) during the intervention. Procedural success was achieved in 90.9% of the cases. Acute lumen gain was 42.7% [30.7‐61.49]. There were no in‐hospital deaths or MACE. At a median follow‐up of 26 months, only one patient (9.1%) suffered MACE in the context of acute coronary syndrome, and two patients (18.2%) required non‐target lesion revascularization. No deaths were reported. CONCLUSIONS: RA of under expanded stents is a feasible option with a high rate of procedural success. At long‐term follow‐up, all of them were alive and 90.9% of patients remained free from MACE.