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Updated: Feb 15, 2026

Three-Dimensional Reconstruction of Orbital Fractures
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Guidewire Entry Into a Calcific Fracture Causing Stent Underexpansion: A Pitfall of Intravascular Lithotripsy
Marohito Nakata1, Tatsuya Tabata1, Toshiya Chinen1
1Department of Cardiology, Urasoe General Hospital, Urasoe, Okinawa, Japan.
Background:
Intravascular lithotripsy (IVL) is a calcium-modification device that delivers acoustic pressure waves to create calcium fractures, thereby improving lesion compliance. IVL-induced fractures achieve larger stent areas than segments without fractures.
Case Summary:
We performed percutaneous coronary intervention on an 86-year-old man for a mid-left anterior descending artery lesion with an optical coherence tomography (OCT) calcium score of 4. IVL was selected. Post-IVL OCT confirmed a deep calcium fracture; however, focal stent underexpansion was observed after stent implantation. OCT showed guidewire entry into the IVL-induced fracture, leading to partial stent deployment within the fracture gap and localized underexpansion.
Discussion:
An IVL-created fracture can become an unintended track for the guidewire and cause focal stent underexpansion.
Take-Home Message:
After IVL, confirm the spatial relationship between the fracture and the guidewire, and rewire before stent implantation when necessary.
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