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Downsizing the intravascular lithotripsy balloon may be necessary to prevent coronary artery rupture when the C-CAT sign is present on intravascular ultrasound in severely calcified lesions.
BACKGROUND: Coronary artery rupture (CAR) is a rare but catastrophic complication of percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been reported to be a safe and effective treatment for severely calcified lesions. CASE SUMMARY: Effort angina pectoris was diagnosed in a 77-year-old man. Coronary artery angiography (CAG) demonstrated significant stenosis in the midsegment of the left anterior descending artery, and intravascular ultrasound showed the C-type calcified and residual thin plaque sign (C-CAT sign). Based on the distal reference diameter, we selected a 3.0-mm IVL balloon. After 60 pulses with IVL, CAR occurred. Immediate balloon tamponade with the IVL balloon followed by implantation of a coronary covered stent resolved the complication. DISCUSSION: The C-CAT sign has been reported to be a potential predictor of CAR in patients with severely calcified lesions. Downsizing the IVL balloon may reduce the risk of CAR when the C-CAT sign is present on intravascular ultrasound.
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Kawanami et al. (2025) studied this question.
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