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Intravascular lithotripsy for optimized percutaneous coronary intervention of a 30-year-old saphenous vein graft: a
Ashwin Kumar1, Vinyas Shraffi Venkatesh1, Boskey Patel2
1Department of Medicine, UConn Health, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030-1235, USA.
Insights
Intravascular lithotripsy (IVL) successfully treated a calcified saphenous vein graft lesion during percutaneous coronary intervention. This case highlights IVL
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Medicine
Background:
- Intravascular lithotripsy (IVL) is FDA-approved for native coronary artery calcification.
- Limited data exist on IVL utilization within saphenous vein grafts (SVGs).
- Saphenous vein graft disease remains a significant challenge in cardiovascular interventions.
Background:
Intravascular lithotripsy (IVL) is approved for native coronary calcium modification, but data in saphenous vein grafts (SVGs) are scarce.
Case Summary:
An 87-year-old man with remote coronary artery bypass grafting presented with chest pain and was found to have non-ST-elevation myocardial infarction and new left ventricular dysfunction. Angiography revealed severe multi-vessel disease, with an 80% proximal lesion in a 30-year-old SVG collateralizing multiple territories with new wall motion abnormality. Percutaneous coronary intervention with embolic protection was attempted, but dense circumferential calcification limited balloon expansion. IVL with a 2.5 mm Shockwave balloon delivering 120 pulses allowed intravascular ultrasound passage, successful stent deployment, and satisfactory expansion.
Discussion:
This case demonstrates successful off-label IVL use in SVG percutaneous coronary intervention, adding to limited reports and highlighting its potential in challenging revascularization.
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