Intravascular Lithotripsy in Calcified under Deployed Stents

By Rohit Mody
like off


Rohit Mody


Rohit Mody


Complex PCI - Calcified Lesion

Intravascular Lithotripsy in Calcified under Deployed Stents

Rohit Mody

Clinical Information

Patient initials or Identifier Number

case1- 202204 Case2- 176683

Relevant Clinical History and Physical Exam

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

Case 2- 
59 year old male
Post PCI to RCA
Known case of Hypertension
Presented with AOE
Vitals- Stable

Relevant Test Results Prior to Catheterization

Case 1- LV Dysfunction, EF 35%
Case 2- Normal LV functions, EF  58%

Relevant Catheterization Findings

Case1- Diffused ISR with highly calcified LAD 
Case2- Diffused ISR with calcified RCA, previously 2 Everolimus eluting DES 2.5x48mm & 3.0x40mm in RCA

Interventional Management

Procedural Step

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,

Case Summary

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.