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Case Reports in Cardiology
Volume 2017, Article ID 3168067, 3 pages
Case Report

Undilatable Stent Neoatherosclerosis Treated with Ad Hoc Rotational Atherectomy

1Cardiology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece
2Cardiac Surgery Department, Evaggelismos General Hospital, Athens, Greece

Correspondence should be addressed to Maria Agelaki; moc.liamg@ikalegam

Received 5 July 2016; Accepted 10 November 2016; Published 10 January 2017

Academic Editor: Nurten Sayar

Copyright © 2017 Michael Koutouzis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A middle age woman with known ischemic heart disease and old stents in proximal left anterior descending coronary artery (LAD) was admitted to Coronary Care Unit with acute coronary syndrome. The coronary angiography showed one vessel disease with significant restenosis within the previously implanted stents. The lesion was tough and remained undilatable despite high pressure balloon inflation. Eventually, the balloon ruptured creating a massive dissection of the LAD beginning immediately after the distal part of the undilatable lesion. We proceeded with a challenging ad hoc rotational atherectomy of the lesion and finally stenting of the lesion. In-stent restenosis many years after stent implantation is considered to be mainly due to neoatheromatosis compared to intimal hyperplasia, making lesion treatment more difficult and unpredictable.