Pradhan A, Vishwakarma P, Bhandari M, Sethi R. Intravascular lithotripsy for coronary calcium: A case report and review of the literature. World J Cardiol 2022; 14(9): 496-507 [PMID: 36187430 DOI: 10.4330/wjc.v14.i9.496]
Corresponding Author of This Article
Monika Bhandari, MBBS, MD, Additional Professor, Department of Cardiology, King George Medical University, Shahmina Road, Chowk, Lucknow 226006, Uttar Pradesh, India. drmonikab@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Akshyaya Pradhan, Pravesh Vishwakarma, Monika Bhandari, Rishi Sethi, Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
Author contributions: Pradhan A and Bhandari M devised the project, performed the literature search, wrote the first draft and prepared the final manuscript; Vishwakarma P and Bhandari M collected the data; Vishwakarma P and Sethi R critically reviewed and suggested changes; Vishwakarma P created all the images; Sethi R revised the entire manuscript and prepared the final version; Pradhan A, Bhandari M and Vishwakarma P submitted the revised version.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent for publication of anonymized data.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Check list (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monika Bhandari, MBBS, MD, Additional Professor, Department of Cardiology, King George Medical University, Shahmina Road, Chowk, Lucknow 226006, Uttar Pradesh, India. drmonikab@gmail.com
Received: May 2, 2022 Peer-review started: May 2, 2022 First decision: May 31, 2022 Revised: July 6, 2022 Accepted: August 26, 2022 Article in press: Auguest 26, 2022 Published online: September 26, 2022 Processing time: 140 Days and 16.4 Hours
Abstract
BACKGROUND
Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events. Aggressive balloon post-dilatation though helpful is usually inadequate. Multiple plaque ablation techniques are in vogue, but they are technically demanding and are not without complications. Shockwave intravascular lithotripsy (S-IVL) has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin. A series of trials (DISRUPT CAD I-IV) have demonstrated both short-term and long-term safety and efficacy of the technique. As experience with the technique grows more and more, therapy areas like stent restenosis are being covered by the S-IVL.
CASE SUMMARY
We report a series of 2 cases successfully managed with S-IVL therapy at our center. The first case is of a 57-year-old smoker who presented with acute coronary syndrome. His left anterior descending coronary artery revealed calcified 90% stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging. The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted. The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram. She also demonstrated a mixture of superficial and deep seated calcium zones on imaging. S-IVL therapy was applied to generate fractures in calcium, and two overlapping drug-eluting stents were implanted successfully without any complications.
CONCLUSION
S-IVL is an emerging, efficient, user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.
Core Tip: The presence of severe calcification in coronary arteries poses a challenge for the interventional cardiologist. If inadequately addressed, it leads to inadequate stent expansion, difficulty in delivery of stent/balloon, balloon rupture, stent dislodgement, stent thrombosis and even perforation. Intravascular lithotripsy is a novel technique utilizing ultrasonic waves to disrupt the calcium in the vessel wall while retaining them in situ. With the accumulation of data and growing expertise of operators with intravascular lithotripsy, it is turning out to be an indispensable tool in catheterization laboratory. We present 2 cases in which intravascular lithotripsy was successfully utilized.
