Intravascular Lithotripsy for Severe Stent Underexpansion

Abstract

Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with a high incidence of complications and long-term adverse outcomes as the suboptimal coronary stent expansion due to calcified lesion is one of the strongest predictors of adverse outcomes. Shockwave intravascular lithotripsy (S-IVL) is a new technique used in the optimal debulking and preparation of severely calcified coronary artery stenoses, but there is few data on its efficacy in acute or postponed optimization of underexpanded stents. We report a case of a 66-year-old male patient with severe underlying calcification of LAD and a marked stent underexpansion after PCI of chronic total occlusion (CTO) due to a lack of adequate predilatation and postdilatation, where S-IVL was applied, resulting in excellent stent expansion. S-IVL could be considered for treating acute and late stent underexpansion caused by severe underlying calcification.

Keywords

• Calcified coronary lesions
• Complication
• Coronary artery disease
• Intravascular lithotripsy
• Percutaneous coronary intervention
• Stent underexpansion