Ablation of Underexpanded and Malapposed Coronary Stent: Optical Coherence Tomography in Detecting Struts Migration: A Case Report | Insight Medical Publishing

Rotactional atherectomy represents an interesting and readily available opportunity to ablate under expanded and undilatable coronary stents forcefully implanted into ill prepared lesions (stent ablation). In this setting, the intracoronary imaging by OCT is an essential tool for a deep analysis in order of procedural planning, with comprehension of potential critical points. We present a case of stent ablation of an under expanded stent with proximal struts malapposition. By OCT analysis with rendered imaging of the stent, we observed a singular OCT finding: the proximal migration in the left main of the struts of the malapposed part of the stent, proximal to the site of the under expansion and subsequent stent-ablation. No other similar finding was previously reported in literature. In this contest the OCT ausilium allowed without any doubt the correct identification of this potential dangerous feature and determined a change in the procedural strategy.