Advertisement

Smart solution for hard times: successful lithoplasty of an undilatable lesion

  • J. Vainer
  • A. LuxEmail author
  • M. Ilhan
  • R. A. L. J. Theunissen
  • S. Aydin
  • A. W. J. van ’t Hof
Open Access
Heart Beat
  • 44 Downloads

After unsuccessful percutaneous coronary interventions (PCI) with high-pressure balloons (40 atm) and rotational atherectomy (1.5 mm burr), a 70-year-old woman was re-admitted for lithoplasty-assisted PCI. Lithoplasty balloons (Shockwave Medical, Freemont, California) were developed based on the principles of kidney stone treatment. With an array of emitters they generate pulsatile, circumferential sonic pressure waves to selectively disrupt intimal and medial calcifications, usually resulting in calcium tears and focal dissections [1, 2].

In this patient with Canadian Cardiovascular Society Class II angina, the 6 Fr compatible device effectively modified the extremely resistant lesion (Fig. 1a). Optical coherence tomography (OCT) showed typical calcium tears and a large dissection (Fig. 1b; [2, 3, 4]). To cover the lesion, a drug-eluting stent (4.5 mm) was implanted and post-dilated with a non-compliant balloon. Proper stent expansion and apposition were confirmed with OCT.
Fig. 1

Images of the lesion before and after lithoplasty and OCT images. On the left (a) pre-lithoplasty (post-rotational atherectomy) and post-lithoplasty angiographic images of the diffusely diseased right coronary artery (RCA) are shown. Within the proximal segment a significant, extremely calcified lesion (white arrow) can be seen. Lithoplasty resulted in plaque modification and a significant increase in diameter. Residual contrast was noticed within the dissection flap (red arrows), and OCT images on the right (b) showed two tears (red stars) and an extensive dissection (red arrow) in the luminal ring and subintimal calcifications (white dotted line and stars respectively)

In conclusion, lithoplasty may become an essential and safe plaque modification tool, especially in coronary arteries with large inner diameters and subintimal calcifications [2].

Notes

Conflict of interest

J. Vainer, A. Lux, M. Ilhan, R.A.L.J. Theunissen, S. Aydin and A.W.J. van ’t Hof declare that they have no competing interests.

References

  1. 1.
    Brinton T, Hill J, Ali Z. DISRUPT CAD: a multicenter, prospective, single-arm study of percutaneous lithoplasty prior to stent implantation in heavily calcified coronary lesions. J Am Coll Cardiol 68 (TCT Suppl). 2016. https://www.tctmd.com/slide/disrupt-cad-multicenter-prospective-single-arm-study-percutaneous-lithoplasty-prior-stent. Accessed 17 Jan 2019.Google Scholar
  2. 2.
    Serruys PW, Katagiri Y, Onuma Y. Shaking and breaking calcified plaque: lithoplasty, a breakthrough in interventional armamentarium? JACC Cardiovasc Imaging. 2017;10:907–11.CrossRefGoogle Scholar
  3. 3.
    Ali ZA, Brinton TJ, Hill JM, et al. Optical coherence tomography characterization of coronary lithoplasty for treatment of calcified lesions: first description. JACC Cardiovasc Imaging. 2017;10:897–906.CrossRefGoogle Scholar
  4. 4.
    De Silva K, Roy J, Webb I, et al. A calcific, undilatable stenosis: lithoplasty, a new tool in the box? JACC Cardiovasc Interv. 2017;10:304–6.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • J. Vainer
    • 1
    • 2
  • A. Lux
    • 1
    • 2
    Email author
  • M. Ilhan
    • 1
  • R. A. L. J. Theunissen
    • 1
  • S. Aydin
    • 3
  • A. W. J. van ’t Hof
    • 1
    • 2
  1. 1.Heart+Vascular CenterMaastricht UMC+MaastrichtThe Netherlands
  2. 2.Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
  3. 3.VieCuri Medical CenterVenloThe Netherlands

Personalised recommendations