Optimización del stent en calcificación coronaria severa: litotricia intravascular en una lesión circunferencial de la arteria descendente anterior. Reporte de un caso

Fernando Quevedo-Candela; Christian Nolte-Rickards; Tomas Cieza

doi:10.47487/apcyccv.v7i3.630

Authors

Fernando Quevedo-Candela Sector de Hemodinamia y Cardiología Intervencionista, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canadá; Université Laval, Québec, Canadá. https://orcid.org/0009-0009-5700-4372
Christian Nolte-Rickards Clínica Delgado, Lima, Perú. https://orcid.org/0000-0001-6910-6880
Tomas Cieza Sector de Hemodinamia y Cardiología Intervencionista, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canadá; Université Laval, Québec, Canadá. https://orcid.org/0000-0002-8547-3004

DOI:

https://doi.org/10.47487/apcyccv.v7i3.630

Keywords:

Coronary Artery Calcification, Percutaneous Coronary Intervention, Lithotripsy, Ultrasonography, Interventional, DrugEluting Stents, Coronary Artery Disease

Abstract

Severe coronary artery calcification reduces vessel compliance and predisposes to failed predilatation and stent underexpansion; intracoronary imaging is therefore essential to guide and verify lesion preparation. We report a 61-year-old man with hypertension and angina. Coronary CT angiography showed extensive circumferential calcification of the left anterior descending artery (LAD). Coronary angiography revealed a 60% stenosis in the proximal-to-mid LAD, and intravascular ultrasound (IVUS) confirmed 360° circumferential calcium, a minimum lumen area of 3.35 mm², and failure of predilatation with a non-compliant balloon. Intravascular lithotripsy was performed using a 3.25 × 12 mm balloon, delivering 60 pulses at 6 atm. IVUS subsequently showed deep calcium fractures, enabling implantation of a drug-eluting stent and achieving 97% stent expansion, a final minimum lumen area of 12.56 mm², and an optimal angiographic result. This case highlights the role of intravascular lithotripsy integrated with intracoronary imaging in restoring vessel compliance and achieving adequate stent expansion in circumferential calcification that is not amenable to dilation with conventional strategies.

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