Bail-out intravascular lithotripsy for severe stent underexpansion during primary angioplasty: a case report.

Abstract

BACKGROUND:

Intravascular lithotripsy is safe and effective for the treatment of de novo coronary artery calcifications. Its bail-out use in acute coronary syndrome and for underexpanded stents, although currently off-label, could be the best option when other conventional techniques fail.

CASE SUMMARY:

A patient with an inferior ST-segment elevation myocardial infarction underwent a primary percutaneous coronary intervention. Stent underexpansion due to a heavily calcified lesion was refractory to high-pressure balloon dilatations. Complete stent expansion was achieved with intravascular lithotripsy, as evidenced by intravascular ultrasound, and no acute complications occurred.

DISCUSSION:

Treatment strategies for stent underexpansion due to coronary artery calcifications are still debated. High-pressure non-compliant balloon dilatations are rarely sufficient to gain a complete stent expansion. Rotational and orbital atherectomy are contraindicated in presence of a thrombus. Given the possible risks of stent damages, intravascular lithotripsy is currently not indicated in acutely deployed stents but could be the best bail-out technique for otherwise undilatable stents due to severely calcified plaques.

• Authors: Niccolò Ciardetti, Francesca Ristalli, Giulia Nardi, Carlo Di Mario
• Journal: European heart journal. Case reports (Eur Heart J Case Rep) Vol. 5 Issue 11 Pg. ytab448 (Nov 2021) ISSN: 2514-2119 [Electronic] England
• PMID: 34917883 (Publication Type: Case Reports)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.