Case report demonstrates successful lesion modification using intravascular lithotripsy in a heavily calcified saphenous vein graft, indicating its utility in complex coronary 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 multivessel 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 PCI, adding to limited reports and highlighting its potential in challenging revascularization.
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Kumar et al. (2026) studied this question.
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