Intracoronary Lithoplasty in Percutaneous Treatment of Challenging Calcified Coronary Lesions

Figures

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  Figure 1. Bail-Out Handling of Stent Under-Expansion (A) Left anterior descending artery chronic total occlusion with ambiguous cap. (B) Right-to-left collateral filling. (C) Extensive coronary dissection. (D) “Dog-boning” effect at the narrowest under-expanded stents and contrast-dye staining. (E) Stent boost shows circumferential calcification with severe stent under-expansion. (F, G) Minimal luminal diameter at the narrowest steel obstruction. (H) Intravascular lithotripsy balloon inflation showing full stent expansion.

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  Figure 2. Multivessel Delivery of IVL (A) Multiple right coronary artery (RCA) calcified stenosis. (B) Long calcified left anterior descending coronary artery (LAD) bifurcation lesion (Medina classification: 1-0-1). (C) Intravascular lithotripsy (IVL) at the site of the severely calcified LAD lesion. (D) Optimal LAD final angiographical result. (E to G) Multiple IVL deliveries on RCA. (H) Final angiographic result after 2 overlapped stents.

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  Figure 3. Electrocardiographic Changes (A) At admission. (B) Post-percutaneous coronary intervention mild ST-segment elevation in leads V3–V5. (C) 15 min later, diffuse severe ST-segment elevation. (D) During verapamil infusion. (E) At discharge.

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  Figure 4. Urgent Angiography (A and B) All vessels are patent. (C) Myocardial bridging on the mid-left anterior descending artery segment.