Background: Rotablation is used in heavily calcified lesions when balloon angioplasty fails to expand the lesion before stenting. Case Presentation: A 68-year-old male patient was admitted with angina 9 months after implantation of a 3.5 × 23 mm drugeluting stent in the crux of right coronary artery. Intravascular ultrasound revealed that the strut-to-strut diameter of the stent in the underexpanded region was 1.6 mm. High-pressure balloon inflation up to 26 atm was performed many times and the procedure was again completed with 3.0 and 3.5 mm kissing balloon inflation at 22 atm. After 4 months following the second procedure, the patient was admitted with the same symptoms. This time a 1.75 mm rotablator was used cautiously under low speed (150,000 rpm) to ablate the stent struts which handicap adequate expansion and lead to recurrent stenosis. Conclusion: Rotablation can also be used to fix an underexpanded stent if the other options fail.

Keywords: Underexpanded stent, rotablation, restenosis, heavily calcified lesion