A Severely Calcified, Undilatable, Coronary Artery Stenosis: Impact of Serial Lithotripsy on Calcium Fracture and Lumen Expansion.

Percutaneous coronary intervention of a severely calcified coronary artery stenosis is associated with stent underexpansion and adverse outcomes. Intravascular lithotripsy (IVL) is a novel technology for fracturing calcified plaque in the coronary artery. We describe the first case of a severely calcified, undilatable coronary artery lesion. After 2 IVL cycles, the balloon expanded, but only 1 calcium fracture occurred by intravascular ultrasound. After 2 additional IVL cycles, there were multiple calcium fractures, and the stent expanded optimally. We concluded that serial IVL cycles lead to multiple calcium fractures and expand the stent optimally.