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Extensive Retrograde Dissection After Intravascular Lithotripsy Balloon Rupture: The Path of Least Resistance
Marohito Nakata1, Tatsuya Tabata1, Toshiya Chinen1
1Department of Cardiology, Urasoe General Hospital, Urasoe, Okinawa, Japan.
Insights
Intravascular lithotripsy (IVL) balloon rupture can cause serious coronary artery dissection. Careful post-rupture management, including limited contrast use, is crucial to prevent further complications.
Area of Science:
- Cardiovascular Interventions
- Medical Device Safety
Background:
- Intravascular lithotripsy (IVL) is a key technique for coronary calcium modification.
- Complications such as balloon rupture during IVL can pose significant clinical risks.
Background:
Intravascular lithotripsy (IVL) is used for coronary calcium modification, but balloon rupture can be clinically serious.
Case Summary:
An 82-year-old woman underwent percutaneous coronary intervention for a severely calcified stenosis in the mid-left anterior descending coronary artery. During IVL pulse delivery, the balloon ruptured. Angiography showed no perforation or dissection; however, contrast injection for optical coherence tomography was followed by extensive retrograde dissection. Bailout stenting from the left anterior descending coronary artery to the left main coronary artery was performed. The final angiography demonstrated a distal filling defect in the left circumflex artery, and intravascular ultrasound confirmed dissection extending from the left circumflex artery ostium to the distal segment.
Discussion:
This finding suggests rupture-related focal injury with hydraulic propagation during contrast injection and potential extension beyond the treated vessel.
Take-Home Messages:
After IVL rupture, minimize contrast injection, avoid repeat optical coherence tomography, and reassess the entire coronary tree.
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