Intravascular Lithotripsy for Suprarenal Coral Reef Aorta: A Novel Endovascular Approach to Complex Calcified Disease

Coral reef aorta (CRA) is a rare atherosclerotic disease characterized by the presence of exophytic, calcified lesions protruding into the aortic lumen, causing severe stenosis of the aorta and its visceral and renal branches. Clinical presentation varies depending on the location and extent of the lesion. Treatment options include open surgery and endovascular approaches. Intravascular lithotripsy (IVL) is a novel endovascular technique that delivers acoustic shockwaves to modify calcified lesions, allowing luminal expansion. We report the case of a 76-year-old female with severe stenosis of the suprarenal aorta, right renal artery, superior and inferior mesenteric artery, and occluded left renal artery. Due to the anatomical complexity and lack of suitable landing zones, the suprarenal aorta was treated with IVL alone without stent or stent-graft placement. To preserve mesenteric perfusion, a balloon-expandable stent was deployed in the inferior mesenteric artery, which served as the dominant supply due to severe superior mesenteric artery stenosis. Following IVL, the patient reported immediate symptom resolution with no periprocedural complications. This case highlights the potential role of IVL as a safe, effective standalone treatment for complex CRA cases.