Lithotripsy for calcified in-stent restenosis. The "rock strata peeling pattern": A novel fracture pattern detected by optical coherence tomography
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Updated: Aug 25, 2025

Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
David Del Val1,2, Javier Cuesta1,2, Pilar Roquero1
1Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain.
Abstract:
Calcified neoatherosclerosis represents a particularly challenging scenario in patients with in-stent restenosis (ISR), frequently associated with worse angiographic and optical coherence tomography (OCT) results compared with other patients with typical ISR. Intravascular lithotripsy (IVL) has emerged as a safe and effective technology to circumferentially modify calcium in heavily calcified coronary lesions. Preliminary data also suggest its usefulness in calcified neoatheroscerosis. This case report aims to describe a novel fracture pattern after IVL identified by OCT (the "rock strata peeling pattern") in patients presenting with ISR due to calcified neoatherosclerosis.
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