Intravascular lithotripsy for stent under-expansion: Panacea or Pandora's box?

Balloon undilatable lesions are common and can be challenging to treat, especially within stents, and require a systematic, algorithmic approach. Stent under-expansion is usually treated with high-pressure balloon inflations, followed by plaque modification balloons, laser with contrast, orbital or rotational atherectomy, and subintimal crossing with coronary artery bypass graft being the ultimate solution is all techniques fail to expand the stent. Intravascular Lithotripsy (IVL) appears to be an easy to use and effective tool for treating stent under-expansion, but further study is needed to confirm its efficacy and (acute and long-term) safety.