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Intravascular lithotripsy to treat an underexpanded coronary stent: 4-Month angiographic and OCT follow-up

Mohammed Alawami1, Sharmaine Thirunavukarasu1, Javed Ahmed2

  • 1Manchester Royal Infirmary, Manchester, UK.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 21, 2020
PubMed

Insights

Intravascular lithotripsy effectively treated underexpanded stents after percutaneous coronary intervention for severe calcified coronary artery disease. This approach ensured excellent stent expansion and long-term lumen gain, improving patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) is a standard treatment for coronary artery disease.
  • Severe calcification and underexpanded stents pose significant challenges during PCI, potentially leading to suboptimal outcomes.

Observation:

  • A 79-year-old man with stable angina presented with a severely calcified left circumflex lesion requiring PCI.
  • Despite aggressive lesion preparation with balloon angioplasty and rotablation, the implanted stent remained underexpanded and unresponsive to post-dilatation.

Findings:

  • The patient underwent intravascular lithotripsy (IVL) six weeks later, achieving excellent stent expansion.
  • Follow-up angiography and optical coherence tomography (OCT) at four months demonstrated sustained acute lumen gain without stent recoil or in-stent restenosis.

Implications:

  • Intravascular lithotripsy is a viable and effective treatment option for managing underexpanded stents in complex calcified lesions.
  • This case highlights the potential of IVL to improve PCI success rates and long-term stent patency in challenging coronary anatomies.

Keywords:
coronary calcificationnon-expandable lesionsrotablation

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