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Intracoronary lithotripsy for calcific neoatherosclerotic in-stent restenosis: a case report

Helena Tizón-Marcos1,2,3, Iris Rodríguez-Costoya1,2,3, Cristina Tevar1,2

  • 1Cardiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain.

European Heart Journal. Case Reports
|September 25, 2020
PubMed

Insights

Intravascular lithotripsy successfully treated calcific neoatherosclerosis causing in-stent restenosis. Balloon rupture occurred but did not harm the artery, highlighting a new complication of this promising treatment.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • In-stent restenosis (ISR) poses a significant challenge in percutaneous coronary interventions.
  • Calcific neoatherosclerosis is a complex etiology underlying difficult ISR cases.
  • Management of severely calcified lesions requires advanced treatment strategies.

Observation:

  • A patient with prior percutaneous coronary intervention (PCI) presented with non-ST-elevation myocardial infarction.
  • Intracoronary imaging revealed ISR attributed to calcific neoatherosclerosis.
  • Intravascular lithotripsy (IVL) was employed to fracture the calcified plaque.

Findings:

  • IVL effectively fractured the calcified neoatherosclerotic plaque in the left anterior descending coronary artery.
  • A balloon rupture occurred during the IVL procedure.
  • Despite the balloon rupture, no arterial damage was observed.

Implications:

  • Intravascular lithotripsy shows promise for treating extremely calcified lesions, including calcific neoatherosclerosis in ISR.
  • Balloon rupture is an identified complication of IVL, necessitating further investigation and management strategies.
  • This case expands the understanding of IVL procedural risks and benefits in complex coronary interventions.
Abstract

Keywords:
Case reportDrug-eluting stentIntracoronary lithotripsyPlaque modificationRestenosis

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