INTRAVASCULAR LITHOTRIPSY FOR SEVERE STENT UNDEREXPANSION
Dario Dilber1,2,3, Igor Šesto1,4, Janko Szavits-Nossan1
1Magdalena Clinic for Cardiovascular Disease at the School of Medicine of the Josip Juraj Strossmayer University in Osijek, Ljudevita Gaja 2, 49217 Krapinske Toplice, Croatia.
Acta Clinica Croatica
|July 2, 2025
Summary
Shockwave intravascular lithotripsy effectively treats underexpanded stents in heavily calcified coronary lesions. This technique can improve stent expansion, even in challenging chronic total occlusion cases.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Medical Device Technology
Background:
- Heavily calcified lesions pose challenges during percutaneous coronary intervention (PCI), often leading to suboptimal stent expansion and adverse outcomes.
- Underexpanded stents, a known predictor of poor long-term results, can result from inadequate lesion preparation in calcified arteries.
Observation:
- A case study involving a 66-year-old male with severe left anterior descending (LAD) artery calcification and significant stent underexpansion post-PCI for chronic total occlusion (CTO).
- The patient experienced marked stent underexpansion due to insufficient predilatation and postdilatation during the initial procedure.
Findings:
- Shockwave intravascular lithotripsy (S-IVL) was successfully employed to address the underexpanded stent.
- S-IVL treatment resulted in excellent stent expansion, overcoming the limitations imposed by severe calcification.
Implications:
- S-IVL demonstrates potential as a valuable tool for optimizing stent expansion in cases of acute and late underexpansion caused by severe coronary calcification.
- This case suggests S-IVL may be a viable option for improving procedural success and long-term outcomes in complex PCI scenarios involving calcified lesions.
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