Bail-out intravascular lithotripsy for the treatment of acutely underexpanded stents in heavily calcified coronary lesions: A case series

Abstract Background The percutaneous treatment of heavily calcified coronary lesions is challenging and presents high rate of complications. Unexpandable stent is one of the most serious complication. Both of these conditions may benefit from the intracoronary lithotripsy (ICL-Shockwave®), a new coronary percutaneous technique. Case summary This case report describes a man treated with percutaneous coronary intervention (PCI) for a left main (LM) severe calcified lesion. The PCI was complicated by a huge dissection of LM in a not completely expandable lesion. A bail-out stent implantation was performed with residual unexpansion. The ICL permitted to expand acutely the stent and obtain an optimal final result. Discussion Familiarity with dedicated techniques and devices to treat calcified coronary lesions is fundamental to perform high-risk complex PCI. This case emphasizes the potential usefulness of the new ICL technique to treat calcified lesions or related complications like unexpandable stent.

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Rota-Lithotripsy—A Novel Bail-Out Strategy for Calcified Coronary Lesions in Acute Coronary Syndrome. The First-in-Man Experience

Journal of Clinical Medicine ◽

10.3390/jcm10091872 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1872

Author(s):

Adrian Włodarczak ◽

Piotr Rola ◽

Mateusz Barycki ◽

Jan Jakub Kulczycki ◽

Marek Szudrowicz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Case Series ◽

Coronary Syndrome ◽

Case Series Study ◽

Risk Patients ◽

Artery Disease ◽

Series Study ◽

Bail Out ◽

Calcified Coronary Lesions

Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed a rota-lithotripsy—a combination of rotational atherectomy with subsequent intravascular lithotripsy—as a novel bail-out strategy to facilitate stent delivery in a tortuous calcified coronary artery.

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“RotaTripsy: Combination of rotational atherectomy and intravascular lithotripsy in heavily calcified coronary lesions: A case series”

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2021.04.011 ◽

2021 ◽

Author(s):

Ariana Gonzálvez-García ◽

Santiago Jiménez-Valero ◽

Guillermo Galeote ◽

Raúl Moreno ◽

Esteban López de Sá ◽

...

Keyword(s):

Case Series ◽

Rotational Atherectomy ◽

Coronary Lesions ◽

Calcified Coronary Lesions

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TCT CONNECT-169 Case Series: Treatment of Severe Calcified Coronary Lesions Via Shockwave (Intravascular Lithotripsy), Single-Center Experience at St. Boniface Hospital, Winnipeg, Canada

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.09.181 ◽

2020 ◽

Vol 76 (17) ◽

pp. B72-B73

Author(s):

Qaiser Aleem ◽

Basem Elbarouni ◽

Kunal Minhas

Keyword(s):

Case Series ◽

Single Center ◽

Single Center Experience ◽

Coronary Lesions ◽

Calcified Coronary Lesions

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Is an Aggressive Rotablator Strategy Preferable to a Standard Rotablator Strategy in Patients With Heavily Calcified Coronary Lesions? A Report From the STRATAS Trial

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85350-8 ◽

1998 ◽

Vol 31 (2) ◽

pp. 378A ◽

Cited By ~ 5

Author(s):

T Bass

Keyword(s):

Coronary Lesions ◽

Calcified Coronary Lesions

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Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

Interventional Cardiology Review ◽

10.15420/icr.2016.11.01.33 ◽

2016 ◽

Vol 11 (1) ◽

pp. 33

Author(s):

Yohei Sotomi ◽

◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Rotational Atherectomy ◽

Percutaneous Coronary ◽

Orbital Atherectomy ◽

Long Term Follow Up ◽

Coronary Lesions ◽

Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

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