Coronary perforation after intracoronary lithotripsy in a chronic total coronary occlusion

Abstract

To the Editor, The management of chronic total coronary occlusions (CTO) has improved significantly over the last decade and reached success rates close to 85%-90% in contemporary registries.1 However, angiographically severe coronary calcifications are a common limitation of CTOs making revascularization more difficult.2 Intracoronary lithotripsy seems to be a safe and effective alternative for the management of severely calcified coronary lesions through the administration of pulsatile mechanical energy. This energy generates a pressure high enough to crack the intimal and medial calcium while minimizing mechanical damage to the remaining vascular tissues.3 We present the case of a 77 year-old-male with a CTO in the mid left anterior descending coronary artery who underwent elective percutaneous coronary intervention. The distal left anterior descending coronary artery received retrograde flow through the septal collaterals from the right coronary artery (figure 1A).