Intravascular lithotripsy to treat an underexpanded coronary stent during index procedure: A case report study

Abstract

Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with high incidence of complications and long-term adverse outcomes. There is growing evidence of the efficacy of intravascular lithotripsy (IVL) in de novo coronary lesion preparation; however, little experience has been documented within freshly deployed stent underexpansion. We report a 66-year-old male with a marked stent underexpansion despite extensive lesion preparation due to severe underlying calcification. The stent was resistant to balloon postdilatation; therefore, IVL was applied, resulting in excellent stent expansion. IVL could be considered for treating acute stent underexpansion caused by severe underlying calcification.

Contemporary Management of Severely Calcified Coronary Lesions

“…The mechanical energy from IVL is distributed uniformly across the inflated balloon into both superficial and deeper layers of the vessel, addressing calcium irrespective of circumferential location and depth [ 58 , 59 ]. Lastly, clinical experience has shown that IVL may also be used to modify calcium in ISR or underexpanded stents implanted in severely calcified lesions [ 60 , 61 , 62 , 63 ], including freshly deployed stents [ 64 ]. Moreover, IVL may be used as an adjunct to other atherectomy techniques when there has been inadequate calcium modification [ 65 ].…”

Litotricia intracoronaria como rescate de un stent infraexpandido

“…Kristian Rivera*, Diego Fernández-Rodríguez, Marta Zielonka, Ignacio Barriuso, Núria Pueyo-Balsells y Juan Casanova-Sandoval 1 Departamento de Cardiología, Hospital Universitari Arnau de Vilanova, Institut De Recerca Biomèdica de Lleida (IRBLLEIDA). Lleida, España.…”

“…La IS incrementa el riesgo de trombosis-reestenosis, de ahí la importancia de su tratamiento, con opciones limitadas. La aterectomía láser presenta problemas logísticos y pocos centros disponen de ella [1][2][3] . A: imagen con StentBoost (Philips Medical Systems ® , Eindoven, Países Bajos) que muestra la infraexpansión distal del stent (asterisco).…”

“…La IS incrementa el riesgo de trombosis-reestenosis, de ahí la importancia de su tratamiento, con opciones limitadas. La aterectomía láser presenta problemas logísticos y pocos centros disponen de ella 1 - 3 .…”

Shockwave intravascular lithotripsy in the treatment of under‐expanded coronary stent: Case Series

“…Clinical registry and case series have recently been published, which showed the effectiveness and safety of S‐IVL to improve refractory stent under‐expansion. 10 , 11 , 12 , 13 , 14 , 15 …”