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Calcified in-stent restenosis: a rare cause of dilation failure requiring rotational atherectomy.

The acute results of repeated interventions for patients with in-stent restenosis (ISR) are largely satisfactory, although some patients may still have recurrences.1,2 In this anatomic scenario, lack of initial angiographic success is exceedingly rare.1,2 We report a patient with “undilatable” ISR that eventually required rotational atherectomy to achieve procedural success. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) unraveled the presence of severely calcified intrastent tissue, leading to “resistant” ISR.

A 77-year-old man on hemodialysis was investigated for unstable angina. Coronary angiography revealed ISR of a bare metal stent that had been implanted in the right coronary artery 10 years before (Figure 1A). A saphenous vein graft to the left anterior descending coronary artery and a drug-eluting stent implanted …