Shockwave lithotripsy for stent underexpansion as a result of severely calcified neoatherosclerosis and in-stent restenosis

Shockwave lithotripsy is a novel therapy to treat severely calcified lesions. The effectiveness of shockwave lithotripsy to treat severely calcified lesions and stent underexpansion due to severe calcifications has been demonstrated. However, this is the first case to demonstrate the use of shockwave lithotripsy in stent underexpansion due to severely calcified in-stent restenosis. A woman in her early 50s presented with angina. The coronary angiogram showed severe three-vessel coronary artery disease with in-stent restenosis in the left anterior descending. After stent implantation in the left anterior descending, there was persisting stent underexpansion due to severely calcified in-stent restenosis. Shockwave lithotripsy contributed to the improvement of angiographic and haemodynamic results. Although evidence is still limited, shockwave lithotripsy could be a valuable tool for treatment of stent underexpansion as a result of severely calcified in-stent restenosis. More studies are needed to confirm the incremental value of shockwave lithotripsy in stent underexpansion.