{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:04Z","timestamp":1753876204201,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Lesions with calcified nodules (CNs) have a significantly higher rate of restenosis. There is no definitive and effective medication or procedural technique to suppress the progression of CNs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 71-year-old was referred to our hospital because of typical effort angina pectoris. Diagnostic coronary angiography identified significant severe stenosis in the middle segment of right coronary artery (RCA). In the primary percutaneous coronary intervention (PCI), intravascular ultrasound visualized the eccentric protruding high echoic structure with irregular surface indicating CNs. Percutaneous coronary intervention was successfully performed with rotational atherectomy (RA). However, one year after the PCI, effort angina was recurrent. The patient experienced recurrent restenosis three times, even after repeated PCI using RA and treatment with drug coating balloon. In the fourth PCI, we tried guide wire penetration through the CNs before RA to reduce the more amount of CNs tissue; finally, good patency was achieved. At last, follow-up angiography after final PCI showed no in-stent restenosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>We report a case of a patient who required repeated revascularization to a severe stenotic lesion with CNs in the middle segment of the RCA. Rotational atherectomy after wire penetration into the CNs was effective to avoid a malignant cycle of restenosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf268","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T10:14:27Z","timestamp":1748859267000},"source":"Crossref","is-referenced-by-count":0,"title":["An effective treatment for repeated coronary in-stent restenosis using rotational atherectomy after aggressive wire penetration through the calcified nodule: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2303-3718","authenticated-orcid":false,"given":"Yasuo","family":"Tsuru","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital , Kokura, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka 802-8555 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takenori","family":"Domei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital , Kokura, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka 802-8555 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Hyodo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital , Kokura, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka 802-8555 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Morofuji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital , Kokura, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka 802-8555 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lithotripsy","volume":"20","author":"Angela","year":"2024","journal-title":"EuroIntervention"},{"key":"2025061005565816400_ytaf268-B6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jccase.2020.04.004","article-title":"Ostial left circumflex lesion with calcified nodule successfully treated with excimer laser coronary atherectomy and drug-coated balloon","volume":"22","author":"Matsuda","year":"2020","journal-title":"J Cardiol Cases"},{"key":"2025061005565816400_ytaf268-B7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1253\/circj.CJ-19-0748","article-title":"Successful disruption of massive calcified nodules using novel shockwave intravascular lithotripsy","volume":"85","author":"Warisawa","year":"2019","journal-title":"Circ J"},{"key":"2025061005565816400_ytaf268-B8","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1177\/15266028211057091","article-title":"The effect of aggressive wire recanalization in calcified atheroma and dilatation (ARCADIA) technique in eccentric calcified lesion of no-stenting zone","volume":"29","author":"Konishi","year":"2022","journal-title":"J Endovasc Ther"},{"key":"2025061005565816400_ytaf268-B9","doi-asserted-by":"crossref","first-page":"749","DOI":"10.4244\/EIJ-D-21-00976","article-title":"Prevalence and outcomes of stent thrombosis with in-stent calcified nodules: substudy from the REAL-ST registry","volume":"18","author":"Takahashi","year":"2022","journal-title":"EuroIntervention"}],"container-title":["European Heart Journal - Case 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