Intravascular Lithotripsy and Impella Support to Assist Complex LM Angioplasty.

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Medical device technology

Background:

• Vascular calcification poses challenges in percutaneous coronary interventions (PCI), increasing complexity and potentially leading to poor outcomes.
• Intravascular lithotripsy (IVL) is an emerging technology designed for plaque modification, showing promise in treating calcified lesions.

Observation:

• A case involving a high-risk patient undergoing left main (LM) percutaneous coronary intervention (PCI) is presented.
• Peripheral IVL was utilized to aid the insertion of a 14 French sheath for Impella CP device delivery.
• Coronary IVL was employed to prepare a severely calcified left main bifurcation lesion prior to stent implantation.

Findings:

• The combined use of peripheral and coronary IVL successfully facilitated the complex PCI procedure.
• The IVL technology enabled plaque modification in a challenging calcified LM bifurcation lesion.
• Successful stent deployment was achieved after lesion preparation with IVL.

Implications:

• Intravascular lithotripsy offers a viable solution for managing complex calcified lesions in PCI, particularly in the challenging left main bifurcation.
• This case highlights the potential of IVL to improve procedural success rates and device delivery in high-risk cardiovascular interventions.
• IVL may expand treatment options for patients with severe vascular calcification undergoing complex coronary procedures.