Severe Concentric Calcific Neo Atherosclerosis: Effectiveness of Ultra-high-pressure Balloon

Concentric calcific neo atherosclerosis is a rare cause of in-stent restenosis, which is more common in bare metal stents (BMS). It is a cause of undilatable lesions during the intervention and needs additional lesion preparation. 1 We report the use and effectiveness of ultra-high pressure balloons in this setting with intravascular imaging. A 68-year-old man with a history of percutaneous coronary intervention (PCI) to the left anterior descending artery (LAD) in 2008 with a bare-metal stent now presented with unstable angina. Coronary angiography showed severe restenosis of the LAD stent with slow flow (Figure 1A). The first optical coherence tomography (OCT) run showed intimal hyperplasia with severe concentric calcific neoatherosclerosis in the proximal stent with calcium extending more than 180 degrees in circumference (Figure 1B). Predilation with noncompliant