Dear Jack, Presence of a stent does make it difficult to advance balloons and other stents or other devices in the distal artery, but this is by no means impossible. These kind of interventions are routinely done by experienced cardiologists. The cutting devices are of various kinds - from Laser based devices to rotablators. Again experience in using all these devices as well as specific details regarding the type of stents, size of stents, exact location of the stent etc. are needed before determining what is possible or advisable. I hope I have answered some of your questions.
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