Journal of Cardiology Cases最新文献

{"title":"Thoracic endovascular aortic repair using a Najuta thoracic fenestrated stent graft for type B aortic dissection with an aberrant right subclavian artery","authors":"Tatsuya Ozaki MD ,&nbsp;Taro Nakazato MD, PhD ,&nbsp;Yosuke Hata MD ,&nbsp;Katsukiyo Kitabayashi MD, PhD","doi":"10.1016/j.jccase.2026.01.002","DOIUrl":"10.1016/j.jccase.2026.01.002","url":null,"abstract":"<div><div>An aberrant right subclavian artery (ARSA) is a rare vascular malformation, and the surgical treatment of aortic diseases in patients with ARSA often necessitates the use of specialized techniques depending on the location of its orifice. Herein, we report a case of chronic Stanford type B aortic dissection (TBAD) with ARSA and false lumen perfusion of the abdominal branches; entry tear closure was achieved through thoracic endovascular aortic repair (TEVAR) using a fenestrated stent graft while preserving false lumen perfusion. The patient was a 48-year-old man with a 3-year history of acute TBAD with ARSA. Outpatient computed tomography revealed dissecting aortic aneurysm enlargement (&gt;5 mm) over 6 months. As the celiac and superior mesenteric arteries were supplied by the false lumen and only small re-entry tears were identified in the bilateral external iliac arteries, the risk of intestinal ischemia due to stent-graft closure of the entry tear was recognized. To preserve false lumen perfusion, a new re-entry tear was created using a guidewire and percutaneous transluminal angioplasty balloon catheter under intravascular ultrasound guidance, followed by debranching TEVAR with a Najuta thoracic fenestrated stent graft (Kawasumi Laboratories, Inc., Tokyo, Japan). The patient had an uneventful postoperative course and was discharged on postoperative day 10.</div></div><div><h3>Learning objective</h3><div>Entry tear closure with thoracic endovascular aortic repair for type B aortic dissection with an aberrant right subclavian artery often requires complex cervical debranching; however, the use of a Najuta thoracic fenestrated stent graft may simplify the surgical procedure. If the abdominal branches are perfused by the false lumen and the re-entry tear is small, the creation of a new re-entry tear using a guidewire and percutaneous transluminal angioplasty balloon catheter under intravascular ultrasound guidance is a practical approach for preserving false lumen blood flow.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 98-101"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An infant case of double-chambered left ventricle with extensive non-compaction revealed by intraoperative endoscopy","authors":"Toshinobu Ifuku MD ,&nbsp;Noritaka Okada MD, PhD ,&nbsp;Hirofumi Irisa MD ,&nbsp;Yasunori Oshima MD","doi":"10.1016/j.jccase.2026.01.003","DOIUrl":"10.1016/j.jccase.2026.01.003","url":null,"abstract":"<div><div>Coexistence of double-chambered left ventricle (DCLV) and left ventricular non-compaction (LVNC) is exceptionally rare and may present diagnostic challenges. We report a case of an 8-month-old girl who developed severe heart failure due to the combination of these two conditions. Transthoracic echocardiography revealed left ventricular dilatation and hypokinesia, consistent with a dilated cardiomyopathy-like phenotype, together with a septum-like structure dividing the cavity and swirling flow, raising suspicion of DCLV, although hyper-trabeculation could not be fully assessed. Because of persistent heart failure, a left ventricular assist device (LVAD) was implanted as a bridge to transplantation. Intraoperative endoscopy during LVAD implantation revealed a shelf-like septal partition, extensive non-compacted myocardium, and multiple fibromuscular string-like structures. Histopathology of the resected wall demonstrated preserved three-layered myocardium with endocardial fibroelastosis, intratrabecular sinusoids, and subendocardial fibrosis, consistent with LVNC. To our knowledge, this is the first report of infantile-onset heart failure due to combined DCLV and LVNC confirmed by detailed perioperative imaging and histopathology. This case highlights the morphological overlap between DCLV and LVNC and underscores the value of intraoperative endoscopic and histological evaluation when conventional imaging fails to adequately characterize complex ventricular morphology.</div></div><div><h3>Learning objective</h3><div>The diagnosis and differential diagnosis of double-chambered left ventricle and left ventricular non-compaction can sometimes be challenging, as their morphology and pathophysiology may overlap. To highlight the diagnostic limitations of conventional imaging in cases with severe cardiac dilation and dysfunction, and to demonstrate how intraoperative endoscopy and histopathology can offer critical insights into rare congenital cardiomyopathies.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 102-106"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrieval of a dislodged helix-fixation leadless pacemaker using the double-snare technique: A case report","authors":"Yuito Ishida MD,&nbsp;Akinori Sawamura MD, PhD,&nbsp;Hiroki Kajiura MD,&nbsp;Ryota Yamauchi MD,&nbsp;Hiroshi Tashiro MD, PhD,&nbsp;Norio Umemoto MD,&nbsp;Toshio Taniguchi MD,&nbsp;Hisaaki Ishiguro MD, PhD,&nbsp;Kiyokazu Shimizu MD, PhD","doi":"10.1016/j.jccase.2025.12.003","DOIUrl":"10.1016/j.jccase.2025.12.003","url":null,"abstract":"<div><div>Leadless pacemakers (LPs) reduce the risk of lead-related complications, but early dislodgement remains a rare yet serious adverse event. We report the case of an 88-year-old woman with bradycardia–tachycardia syndrome who underwent implantation of an AVEIR™ VR LP (Abbott, Chicago, IL, USA). The procedure was uneventful, with stable electrical parameters and confirmed fixation. However, pacing failure was detected the following day, and imaging revealed that the device had dislodged into the right pulmonary artery. Given the position and orientation of the dislodged device, the dedicated retrieval catheter was deemed unsuitable. Therefore, the double-snare technique was employed using two snare catheters: one inserted through a steerable sheath to grasp the device body, and the other advanced outside the sheath to secure the helix. This approach enabled safe and complete retrieval without vascular injury. The patient subsequently underwent successful transvenous dual-chamber pacemaker implantation and was discharged without complications. Notably, a small amount of myocardial tissue was found attached to the helix, suggesting possible localized myocardial fragility. This case highlights the utility of the double-snare technique as an effective alternative when standard retrieval tools are inadequate for recovering dislodged LPs.</div></div><div><h3>Learning objective</h3><div>Leadless pacemaker (LP) dislodgement into the pulmonary artery is a rare but serious complication that requires prompt recognition and appropriate retrieval. The double-snare technique provides a safe and effective option when standard methods are insufficient. Awareness of potential underlying factors, such as localized myocardial fragility, may guide risk assessment and management. Understanding such cases enhances patient safety and supports best practices in LP therapy.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 86-88"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful atrial fibrillation ablation following bariatric surgery in Japanese patients with extreme obesity","authors":"Toshinaru Kawakami MD ,&nbsp;Hitomi Yuzawa MD, PhD ,&nbsp;Yu Horiuchi MD, PhD ,&nbsp;Masahiko Asami MD ,&nbsp;Kota Komiyama MD, PhD ,&nbsp;Jun Tanaka MD ,&nbsp;Kengo Tanabe MD, PhD","doi":"10.1016/j.jccase.2025.11.004","DOIUrl":"10.1016/j.jccase.2025.11.004","url":null,"abstract":"<div><div>Obesity is a significant risk factor for the development and progression of atrial fibrillation (AF) and is associated with poor outcomes following AF ablation. We present two compelling cases of extremely obese Japanese patients with long-standing persistent AF who underwent laparoscopic sleeve gastrectomy (LSG) prior to successful radiofrequency catheter ablation (RFCA). Both patients maintained sinus rhythm for over 4.5 years post-RFCA, with notable improvements in cardiac parameters, such as reduced left atrial size, and favorable metabolic profiles, including improved glycemic control and decreased N-terminal pro-B-type natriuretic peptide levels. These cases underscore the crucial benefits of weight reduction strategies, particularly bariatric surgery, as a preparatory intervention for AF ablation in this challenging patient population. While severe obesity (body mass index ≥35 kg/m²) has historically been less common in Japan, its prevalence is increasing. This trend highlights a growing number of patients who could benefit from interventions such as LSG. Our report emphasizes the importance of integrating bariatric surgery into the management paradigm for obese AF patients in Japan, demonstrating its efficacy and the growing relevance of a multidisciplinary approach focusing on substantial weight reduction to enhance AF ablation outcomes.</div></div><div><h3>Learning objective</h3><div>This case report highlights the significant impact of bariatric surgery on improving catheter ablation outcomes for atrial fibrillation (AF) in extremely obese patients. It demonstrates how substantial weight reduction can lead to favorable cardiac remodeling and metabolic improvements, enhancing long-term rhythm control after ablation. We emphasize the growing importance of a multidisciplinary approach that integrates weight management into the overall treatment strategy for obese AF patients.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 67-70"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takotsubo syndrome with left ventricular thrombus: Prevention of systemic thromboembolism","authors":"Masato Takeuchi MD ,&nbsp;Katsutoshi Tanioka MD ,&nbsp;Yoshikazu Ohara MD ,&nbsp;Nobuo Kondo MD ,&nbsp;Kensuke Ohue MD ,&nbsp;Hiroaki Kitaoka MD, PhD, FJCC ,&nbsp;Yoshinori Doi MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.10.003","DOIUrl":"10.1016/j.jccase.2025.10.003","url":null,"abstract":"<div><div>Takotsubo syndrome (TTS) may at times be complicated by left ventricular (LV) thrombus with a potential risk of systemic embolism. Case 1: A 65-year-old woman presented with chest pain and electrocardiographic (ECG) features of deep T-wave inversions at leads V3-V6. A broad ballooning of mid-apical LV segments was demonstrated. Despite prophylactic anticoagulation, LV apical thrombus was detected 4 days later. She then experienced right coronary artery embolism, followed by posterior tibial artery embolism, both of which were successfully treated with thrombectomy. Case 2: A 63-year-old woman presented with consciousness disturbance and ECG features of ST-segment elevations at leads V3-V6. A broad ballooning of mid-apical LV segments and apical thrombus were demonstrated. Since LV thrombus became mobile 3 days after starting therapeutic anticoagulation, she underwent surgical removal of apical thrombus to prevent systemic embolism. An educational case series of TTS with LV thrombus is presented. In patients with TTS and LV thrombus, it is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started. In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.</div></div><div><h3>Learning objective</h3><div><ul><li><span>•</span><span><div>Takotsubo syndrome may be complicated by left ventricular (LV) thrombus, reportedly with an incidence rate of 1.3–2.3 %, with a potential risk of systemic embolism.</div></span></li><li><span>•</span><span><div>It is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started.</div></span></li><li><span>•</span><span><div>In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 40-43"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing cardiac device efficacy: A case series on low atrial septal lead placement for intra-atrial conduction disturbances","authors":"Koji Sasaki ,&nbsp;Satoshi Higuchi MD, PhD ,&nbsp;Kaho Hatakeyama ,&nbsp;Momoko Murakami ,&nbsp;Gaku Hatayama MD ,&nbsp;Naoyuki Tanaka MD ,&nbsp;Satoshi Miyazawa MD ,&nbsp;Masahiro Yagi MD, PhD ,&nbsp;Junichi Yamaguchi MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.11.001","DOIUrl":"10.1016/j.jccase.2025.11.001","url":null,"abstract":"<div><div>This case series describes three heart failure patients with right atrial conduction disturbances, where lead placement in the lower atrium was used to optimize intra-atrial conduction. By shortening conduction delays, improving intrinsic conduction, and reducing the atrioventricular interval, this approach enabled successful left ventricular-only pacing. This strategy proved particularly beneficial for patients with prolonged intra-atrial conduction. In all cases, the intervention led to significant improvements in heart failure symptoms. These findings suggest that lower atrial lead placement may enhance the performance of cardiac implantable electronic devices and improve clinical outcomes in patients with complex conduction disorders.</div></div><div><h3>Learning objective</h3><div>This case series highlights lower atrial septal lead placement as an effective strategy for optimizing cardiac device function in patients with intra-atrial conduction disturbances. The pacing technique shortens conduction delays, improves intrinsic conduction, and reduces the atrioventricular interval, facilitating left ventricular-only pacing. This approach is particularly beneficial for patients with prolonged intra-atrial conduction, potentially improving heart failure management and patient outcomes in complex conduction disorders.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 52-55"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous balloon pericardiotomy using the hugging balloon technique: A case series of three high-risk patients with recurrent pericardial effusion","authors":"Asaki Saijo MD,&nbsp;Takahide Kodama MD, PhD, FJCC,&nbsp;Hideomi Fujiwara MD,&nbsp;Chinatsu Komiyama MD, PhD,&nbsp;Ayako Harima MD,&nbsp;Yo Fujimoto MD,&nbsp;Tetsuo Yamaguchi MD, PhD","doi":"10.1016/j.jccase.2025.10.007","DOIUrl":"10.1016/j.jccase.2025.10.007","url":null,"abstract":"<div><div>In patients with recurrent pericardial effusion and poor general condition, surgical intervention is often not feasible, and the establishment of a less invasive yet effective method for continuous drainage remains a clinical challenge. We performed percutaneous balloon pericardiotomy in three patients who developed cardiac tamponade or pre-tamponade due to malignant pericarditis or unexplained recurrent pericardial effusion. All patients were considered unsuitable for surgical procedures due to their poor systemic status. Following the intervention, effective drainage was achieved without recurrence of pericardial effusion, and all patients were able to be discharged home. Percutaneous balloon pericardiotomy may represent a safe and practical alternative for managing recurrent pericardial effusion in patients for whom surgery is not an option.</div></div><div><h3>Learning objective</h3><div>Managing recurrent pericardial effusion in patients with poor general condition remains a clinical challenge, particularly when surgery is not feasible due to advanced malignancy or frailty. Percutaneous balloon pericardiotomy using the hugging balloon technique may offer a minimally invasive and effective alternative, providing symptom relief and facilitating discharge in high-risk patients with otherwise limited treatment options.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 48-51"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversed paradoxical splitting of the second heart sound: A unique case report","authors":"Megumi Takahashi MS,&nbsp;Takashi Muro MD, FJCC,&nbsp;Kazumasa Adachi MD,&nbsp;Rio Shiraki MD,&nbsp;Tomoko Tohda MD,&nbsp;Takeo Nakai MD,&nbsp;Yukikatsu Okada MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.11.003","DOIUrl":"10.1016/j.jccase.2025.11.003","url":null,"abstract":"<div><div>A 73-year-old female presented with split second heart sound (S2) and ejection systolic murmur. The S2 split only during expiration (paradoxical splitting) with a softer second component (pulmonary component), which was in reverse order compared to typical paradoxical splitting (termed reversed paradoxical splitting). Furthermore, the murmur increased during expiration and decreased during inspiration (reversed Rivero-Carvallo's sign). Transthoracic echocardiography revealed a mass adherent to the free wall of the right ventricular outflow tract. Open-heart surgery was performed, and the tumor was surgically resected. Histopathological examination confirmed the diagnosis of a capillary hemangioma. The patient's recovery was smooth and uneventful.</div></div><div><h3>Learning objective</h3><div>Splitting of the second heart sound (S2) sometimes provides significant clinical clues for cardiopulmonary disease. Paradoxical splitting of S2 typically features a softer pulmonary component (P2) followed by a clearer aortic component (A2) during expiration. We encountered a case of paradoxical splitting in which A2 preceded P2 (termed reversed paradoxical splitting) in a patient with right ventricular outflow tract obstruction due to cardiac hemangioma. Auscultation findings were definitive in this case.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 60-62"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 inhibitor-associated euglycemic ketoacidosis after percutaneous coronary intervention for ST-segment elevation myocardial infarction","authors":"Takahiro Kuno MD,&nbsp;Shiro Amanai MD,&nbsp;Noriaki Takama MD, PhD,&nbsp;Hideki Ishii MD, PhD","doi":"10.1016/j.jccase.2025.10.002","DOIUrl":"10.1016/j.jccase.2025.10.002","url":null,"abstract":"<div><div>While sodium-glucose cotransporter-2 (SGLT2) inhibitors improve cardiovascular outcomes after myocardial infarction (MI), they carry the risk of euglycemic diabetic ketoacidosis (euDKA). We report the case of a 60-year-old male with type 2 diabetes mellitus who developed euDKA after a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Despite exhibiting hemodynamic stability, the patient developed persistent metabolic acidosis. The diagnosis of SGLT2 inhibitor-associated euDKA was significantly delayed, as it was obscured by a combination of the patient's clinical stability, an initial normal anion gap acidosis from diarrhea, and the administration of sodium bicarbonate. This case highlights the fact that clinical stability after primary PCI might mask SGLT2 inhibitor-associated euDKA. This report also emphasizes that euDKA should be a critical diagnostic consideration in the face of persistent acidosis in STEMI patients treated with PCI and receiving SGLT2 inhibitors, even when they appear clinically stable.</div></div><div><h3>Learning objectives</h3><div>This case highlights that euglycemic diabetic ketoacidosis (euDKA) might be a critical and missed diagnosis in SGLT2 inhibitor-treated diabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). SGLT2 inhibitor-associated euDKA should be considered in diabetic patients presenting with unexplained metabolic acidosis, even if they are hemodynamically stable and their blood glucose levels are normal. Routine ketone monitoring should be considered in this setting.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 37-39"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bailout intravascular lithotripsy after rotational atherectomy for chronic total occlusion of the right coronary artery with severe calcification: A case report","authors":"Yoichiro Naito MD ,&nbsp;Kazufumi Nakamura MD, FJCC ,&nbsp;Yoshimasa Morimoto MD ,&nbsp;Yasunori Arai MD ,&nbsp;Akihiro Oka MD ,&nbsp;Yuichi Kato MD ,&nbsp;Takaaki Saito MD ,&nbsp;Ryunosuke Takechi MD ,&nbsp;Michihide Okada MD ,&nbsp;Shinsuke Yuasa MD, FJCC ,&nbsp;Masaki Yoshikawa MD","doi":"10.1016/j.jccase.2025.10.006","DOIUrl":"10.1016/j.jccase.2025.10.006","url":null,"abstract":"<div><div>Coronary artery calcification (CAC) is recognized as an independent predictor for major cardiovascular events. Rotational atherectomy (RA), orbital atherectomy system, and intravascular lithotripsy (IVL) are used to treat severe CAC. Among these, IVL is associated with a notably low risk of complications, such as slow flow and coronary artery perforation. A 70-year-old man with exertional angina underwent percutaneous coronary intervention for chronic total occlusion of the right coronary artery. RA was performed on a severely calcified lesion; however, the RA could not be advanced through the lesion, resulting in guidewire rupture and slow coronary flow. Due to the difficulty in proceeding with RA, IVL was attempted as a bailout strategy. Good stent expansion was achieved using IVL for residual calcified lesions, and the ruptured guidewire was secured beneath the stent. In cases where safe treatment cannot be accomplished with RA alone, the use of IVL following RA may be considered desirable.</div></div><div><h3>Learning objective</h3><div>Intravascular lithotripsy (IVL) is associated with a low risk of complications, such as slow flow and coronary artery perforation.</div><div>IVL serves as a useful bailout strategy when rotational atherectomy cannot be continued due to complications such as slow coronary flow and perforation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 2","pages":"Pages 44-47"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}