Optimizing stent deployment in severe coronary calcification: intravascular lithotripsy in a circumferential left anterior descending artery lesion. A case report

Quevedo-Candela F.; Nolte-Rickards C.; Cieza T. · Archivos Peruanos de Cardiologia y Cirugia Cardiovascular (2026) · DOI: 10.47487/apcyccv.v7i3.630

Resumen

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.