Successful Intravascular Lithotripsy For Severely Calcified Left Anterior Descending Coronary Artery Stenosis

Percutaneous coronary intervention (PCI) of heavily calcified stenoses remains a significant challenge to interventional cardiologists. Over the last years, high-pressure balloons, cutting balloons as well as atherectomy devices have been used to tackle such lesions. Lithoplasty is a method of lesion modification using intravascular lithotripsy (IVL, shockwave) to treat particularly calcified coronary lesions. A 55-year-old male without previous cardiac history reported chest pain and was found to have ECG changes anterolaterally and significantly elevated troponins. Coronary angiogram showed heavily calcified severe proximal left anterior descending (LAD) stenosis. The attempts to predilate the lesion with semi-compliant and non-compliant balloons at high pressures were unsuccessful so the decision was made to use a shockwave balloon. Subsequently a drug-eluting stent was successfully implanted and post-dilated at high pressure. Final angiography showed an excellent result, also confirmed in optical coherence tomography (OCT).