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Intravascular Lithotripsy-Assisted Stenting of Supraceliac Coral Reef Aorta Using a Partially Deployed WALLSTENT for
Jithin Jagan Sebastian1, Naveen Kumar K2, Rajasekar Arumugam3
1Department of Vascular and Endovascular Surgery, Naruvi Hospitals, Vellore, India.
Insights
Coral reef aorta (CRA) is a rare condition causing severe aortic blockage. This case study shows successful endovascular treatment using lithotripsy-assisted stenting, improving patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Coral reef aorta (CRA) presents as severe intraluminal calcification, leading to aortic stenosis or occlusion.
- CRA can manifest with critical systemic complications, including heart failure, renal impairment, and hypertension.
Abstract:
Coral reef aorta (CRA) is characterized by dense, rock-hard intraluminal calcified plaques that can cause critical aortic stenosis or occlusion. We report the case of a 59-year-old man who presented with accelerated hypertension, acute decompensated heart failure, bilateral pleural effusions, acute kidney injury, adrenal insufficiency, and progressive inability to ambulate. Computed tomography angiography demonstrated a near-occlusive supraceliac CRA lesion with markedly reduced infraceliac aortic flow. The lesion was successfully treated with intravascular lithotripsy-assisted stenting, During the procedure, a partially deployed WALLSTENT (Boston Scientific) was used for temporary distal embolic protection. The postoperative course was uneventful, with resolution of heart failure, normalization of renal function, improvement in adrenal function, and reduction in antihypertensive requirements from four to two agents. The patient remained asymptomatic at the 6-month follow-up. This case suggests that endovascular management using intravascular lithotripsy-assisted stenting with temporary WALLSTENT-based embolic protection may be feasible for selected patients with complex supraceliac CRA.