Rotational atherectomy: if you do not do it before, you can do it after stenting.

We report the treatment of three severely underexpanded freshly deployed stent layers in the proximal left anterior descending artery, despite 24 atm inflation pressure, due to heavily calcified plaque. Rotational atherectomy, using a high rpm and a stepped burr strategy, successfully ablated the stent layers and the protruding calcified plaque. Subsequently, balloon angioplasty resulted in stent expansion and the treated segment was scaffolded with another stent, finally obtaining an excellent angiographic result. The patient's evolution was satisfactory. This case shows that rotational atherectomy can be a useful tool in a compromising situation, such as severely underexpanded implanted stents.