Coronary angioplasty in severely calcified lesions facilitated by coronary lithotripsy. Case report

Calcified coronary lesions may prevent correct stent expansion and predispose to adverse events. Intracoronary lithotripsy is a new plaque modification tool whose safety and efficacy have been evaluated in the Disrupt CAD II trial. We present the case of a 70-year-old patient who was hypertensive, type II diabetic, dyslipidemic and a smoker, with acute myocardial infarction without ST-segment elevation associated with heart failure. Severe multi-vessel coronary artery disease (severe and diffuse in anterior descending and circumflex arteries, and chronic total occlusion of the right coronary artery) and moderate left ventricular dysfunction; with a Syntax Score of 47; surgical revascularization was indicated. Due to the patient's refusal to this indication, circumflex artery angioplasty was performed and then, in a second stage, in the descending artery. This artery presented severe parietal calcification and severe tortuosity throughout its proximal and middle segment, with significant compromise of its lumen, so intracoronary lithotripsy technique was performed to then implant coronary stents, procedure optimized by intravascular ultrasound (IVUS), obtaining a satisfactory result and without periprocedural complications. Intracoronary lithotripsy has proven to be effective and safe in this highly complex scenario of a real-life patient.