Case 117: PCI Manual - Refractory stent underexpansion

A patient with recurrent in-stent restenosis of the right coronary artery and the LAD was referred for brachytherapy. Diagnostic angiography showed recurrent restenosis of the distal RCA and IVUS showed severe stent underexpansion with minimum lumen area of 4.3 mm2. Despite high-pressure inflations with multiple balloons (NC, Angiosculpt, Chocolate), laser with contrast, rotational atherectomy (1.5 and 1.75 mm burrs), orbital atherectomy (at low and high speed) and intravascular lithotripsy the distal RCA lesion could not be expanded.