case1- 202204 Case2- 176683

Case 1- 67-year-old malePost CABGPost PTCA to LAD Presented with AOE 3DOE 3Non-DiabeticHypertensive

Case 1- LV Dysfunction, EF 35%

Case1- Crossed with BMW wire, Pre Dilatation with 2.5mm balloon showing dog bonning, IVL pulses given, 8 pulses each time 4 times at same place. Full Dilatation of 3mm balloon can be seen at 4ATM, 3.0x15mm DES deployed. Case2- Pre Dilatation and IVL 8 pulses each two times. IVL pulses given from distal RCA to proximal RCA at 4 ATM full expansion observed , 3 DES deployed sirolimus Eluting stents 2.5x30mm at 20 ATM, 3.0x 38mm at 20 ATM, And 3.5x18mm at 20 ATM and post dilated with 3.5x12mm balloon,

Intravascular lithotripsy done first of its kind in world Stent under expanded due to calcified nodule visible on IVUS After IVL pulses calcified nodules showed fracture 3mm balloon expanded and stent deployed 3.5 mm with full expansion Philips sync vision and IVUS coregistration made things clearer. Stent under expansion due to calcification.1) IVL use in calcified ISR2) Sync vision Phillips clearly shows in ISR distance between in inflated balloon and already deployed stent.3) Virtual histology shows fibro calcific lesions undilatable with NC balloons Also necrotic core(Red)indicating future instability.4) Undeployed stent also malopposed.