[The shockwave: an ace in the hole?]

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Medical Technology

Background:

• Severe calcified coronary lesions pose significant technical challenges during angioplasty, leading to increased complications.
• Traditional angioplasty techniques may be insufficient for optimal treatment of heavily calcified coronary arteries.
• Intravascular lithotripsy has emerged as a promising modality for preparing calcified lesions prior to stent implantation.

Observation:

• This article presents three complex clinical scenarios where intravascular lithotripsy (IVL) was utilized.
• Case 1: Stent underexpansion following primary angioplasty for calcified coronary lesions.
• Case 2: Acute myocardial infarction with cardiogenic shock due to left main subocclusive stenosis.
• Case 3: Severely calcified plaque within a venous bypass graft.

Findings:

• In all three complex cases, IVL facilitated successful lesion modification.
• The use of IVL was crucial for achieving optimal stent expansion and procedural success.
• No significant adverse clinical events were observed during or after the IVL procedures.

Implications:

• Intravascular lithotripsy demonstrates safety and efficacy in challenging calcified coronary lesions beyond its currently codified indications.
• IVL offers a valuable therapeutic option for complex coronary interventions, potentially improving patient outcomes.
• Further research and clinical experience are warranted to expand the role of IVL in interventional cardiology.