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Rotational Atherectomy of Three Overlapping Stent Layers.

A patient was referred to us for Canadian Cardiovascular Society class III refractory angina. He was found to have in-stent restenosis within three layers of underexpanded stents implanted in 2004, 2011, and 2014. Rotational atherectomy safely yielded stent strut ablation (reduced to one layer), lesion expansion, and very good angiographic and physiologic results.