LAUSR

A 72-year-old male was admitted for unstable angina due to severe in-stent restenosis (Figure 1). After several attempts using high pressure non compliant balloons, it was impossible to properly prepare the vessel as a result of severely underexpanded first stent implantation (Figure 2). A Shockwave catheter (Shockwave Medical, Fremont US) was used and after 30 pulses the stent was expanded (Figure 3(A,B)). The treatment was completed by a new drug eluting stent with an excellent final angiographic result (Figure 4). A 83-year-old female was admitted for non-ST-myocardial infarction due to a subocclusive ostial circumflex lesion (Figure 5). Previous history included a patent LIMA graft to proximal occluded LAD and patent RIMA graft to PD. The first attempt with low profile semi-compliant balloons failed due to a previous stent implanted in the left main and to severe calcified ostial plaque. A second attempt was made with a Shockwave catheter which successfully crossed after placement of a second more supportive coronary wire (Sion Blue Extra Support, Asahi Intecc.). A good expansion of the balloon was obtained after 40 pulses and the treatment was completed by a drug eluting stent with an excellent angiographic result (Figure 6). Angioplasty of heavily calcified coronary artery lesions remains today is a difficult challenge and can lead to adverse outcomes. We present two clinical cases treated with a novel technology after failure with classical angioplasty. The coronary lithotripsy technique was very efficient, safe and straightforward despite the complexity of the coronary anatomy. No adverse clinical outcome was noticed 30 days after the procedures.