Severe restenosis after stentless treatment with coronary intravascular lithotripsy for calcified nodule lesions: a serial observation with IVUS.

Abstract

An 82-year-old woman with a history of myocardial infarction presented with worsening effort angina. Coronary angiography (CAG) revealed 75% stenosis in the proximal left anterior descending artery (LAD), with intravascular ultrasound (IVUS) identifying a severe calcified nodule near a previously implanted drug-eluting stent. The lesion was treated with intravascular lithotripsy (IVL) and a drug-coated balloon (DCB), avoiding left main crossover stenting. Despite initial success, the patient experienced restenosis three months later, managed conservatively based on favorable DFR/FFR values. However, worsening symptoms led to repeat CAG, revealing 99% restenosis with calcified nodule. A second IVL was performed, followed by crossover stenting from the left main to the LAD, achieving successful stent expansion. This case underscores the potential for severe restenosis following IVL and DCB angioplasty, highlighting the limitations of IVL in reducing calcified plaque volume and the importance of close follow-up.