Optimizing stent deployment in severe coronary calcification: intravascular lithotripsy in a circumferential left anterior descending artery lesion. A case report
- 1Sector de Hemodinamia y Cardiología Intervencionista, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada. Sector de Hemodinamia y Cardiología Intervencionista Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) Québec Canada
- 2Université Laval, Québec, Canada. Université Laval Université Laval Québec Canada
- 3Clínica Delgado, Lima, Peru. Clínica Delgado Lima Peru
Abstract
Severe coronary artery calcification reduces vessel compliance and predisposes to failed predilatation and stent underexpansion; intracoronary imaging is therefore essential to guide and verify lesion preparation. We report a 61-year-old man with hypertension and angina. Coronary CT angiography showed extensive circumferential calcification of the left anterior descending artery (LAD). Coronary angiography revealed a 60% stenosis in the proximal-to-mid LAD, and intravascular ultrasound (IVUS) confirmed 360° circumferential calcium, a minimum lumen area of 3.35 mm², and failure of predilatation with a non-compliant balloon. Intravascular lithotripsy was performed using a 3.25 × 12 mm balloon, delivering 60 pulses at 6 atm. IVUS subsequently showed deep calcium fractures, enabling implantation of a drug-eluting stent and achieving 97% stent expansion, a final minimum lumen area of 12.56 mm², and an optimal angiographic result. This case highlights the role of intravascular lithotripsy integrated with intracoronary imaging in restoring vessel compliance and achieving adequate stent expansion in circumferential calcification that is not amenable to dilation with conventional strategies.
Related
- Intravascular lithotripsy for highly calcified carotid stenoses: distal (filter) protection may not suffice
- Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis
- Treatment of Calcified Peripheral Artery Disease With the Shockwave Forward Peripheral Intravascular Lithotripsy System: One-Year Outcomes From the FORWARD PAD IDE and Mini S Feasibility Studies
- Clinical Outcomes of Intravascular Lithotripsy in Diabetic Patients with Stent Failure: Insights from the COIL Registry
- Incidence of Periprocedural Myocardial Injury and Infarction After Intravascular Lithotripsy for Calcified Coronary Artery Stenosis
BibTeX
@article{quevedocandela2026optimizing,
title = {{Optimizing stent deployment in severe coronary calcification: intravascular lithotripsy in a circumferential left anterior descending artery lesion. A case report}},
author = {Fernando Quevedo-Candela and Christian Nolte-Rickards and Tomas Cieza},
journal = {Archivos Peruanos de Cardiología y Cirugía Cardiovascular},
year = {2026},
month = sep,
doi = {10.47487/apcyccv.v7i3.630},
url = {https://doi.org/10.47487/apcyccv.v7i3.630},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Optimizing stent deployment in severe coronary calcification: intravascular lithotripsy in a circumferential left anterior descending artery lesion. A case report
AU - Fernando Quevedo-Candela
AU - Christian Nolte-Rickards
AU - Tomas Cieza
PY - 2026
DA - 2026/09/26
JO - Archivos Peruanos de Cardiología y Cirugía Cardiovascular
DO - 10.47487/apcyccv.v7i3.630
UR - https://doi.org/10.47487/apcyccv.v7i3.630
AB - Severe coronary artery calcification reduces vessel compliance and predisposes to failed predilatation and stent underexpansion; intracoronary imaging is therefore essential to guide and verify lesion preparation. We report a 61-year-old man with hypertension and angina. Coronary CT angiography showed extensive circumferential calcification of the left anterior descending artery (LAD). Coronary angiography revealed a 60% stenosis in the proximal-to-mid LAD, and intravascular ultrasound (IVUS) confirmed 360° circumferential calcium, a minimum lumen area of 3.35 mm², and failure of predilatation with a non-compliant balloon. Intravascular lithotripsy was performed using a 3.25 × 12 mm balloon, delivering 60 pulses at 6 atm. IVUS subsequently showed deep calcium fractures, enabling implantation of a drug-eluting stent and achieving 97% stent expansion, a final minimum lumen area of 12.56 mm², and an optimal angiographic result. This case highlights the role of intravascular lithotripsy integrated with intracoronary imaging in restoring vessel compliance and achieving adequate stent expansion in circumferential calcification that is not amenable to dilation with conventional strategies.
SN - 2708-7212
ER -