Author + information
- Received February 19, 2015
- Accepted February 26, 2015
- Published online July 1, 2015.
- Da Yin, MD∗,†,
- Akiko Maehara, MD∗,†∗ (, )
- Stephen Mezzafonte, MD‡,
- Jeffrey W. Moses, MD∗,†,
- Gary S. Mintz, MD∗ and
- Richard A. Shlofmitz, MD‡
- ∗Cardiovascular Research Foundation, New York, New York
- †Columbia University Medical Center, New York, New York
- ‡St. Francis Hospital, Roslyn, New York
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022.
A 79-year-old man underwent stent implantation into a severely calcified proximal left anterior descending coronary lesion (Figure 1) in December 2012 followed by restenting in March 2014 to treat in-stent restenosis (Figure 2), both without full balloon expansion. Optical coherence tomography (OCT) documented thick, peri-stent napkin-ring calcium. He was admitted for recurrent unstable angina in April 2014. After initial treatment with excimer laser coronary angioplasty (ELCA; 1.4 mm, Spectranetics Corporation, Colorado Springs, Colorado) using saline injection, fluence of 60 mJ/mm2, and frequency of 80 Hz, a balloon was fully expanded. OCT showed fracturing of peri-stent calcium and good stent expansion (Figure 3). This approach has been reported in the ELLEMENT (Excimer Laser LEsion Modification to Expand Non-dilatable sTents) registry (1); in the current case, we used OCT to document the mechanism behind this approach.
The authors thank Fernando A. Sosa, MS, from St. Jude Medical for his assistance in image collection.
Dr. Maehara has received grant support from Boston Scientific; is a consultant for Boston Scientific and ACIST Medical Systems; and has received speaker’s fees from St. Jude Medical. Dr. Moses is a consultant for Boston Scientific. Dr. Mintz has received grant support and is a consultant for Boston Scientific and Volcano Corporation. Dr. Shlofmitz is on the speakers bureaus of CSI, Janssen Pharmaceuticals, and St. Jude Medical. Drs. Yin and Mezzafonte have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 19, 2015.
- Accepted February 26, 2015.
- American College of Cardiology Foundation