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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary intravascular lithotripsy &#40;IVL&#41; has been postulated as a new option for the treatment of non-dilatable calcified lesions&#46; Its use in underexpanded stents is off-label&#44; given the damage it may cause to the polymer or scaffold of the device&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A drug-eluting stent implanted the previous month in the mid anterior descending artery showed severe central underexpansion&#46; Despite prolonged post-dilatation with a non-compliant balloon &#40;3&#46;5 mm at 22 atm for 10 min&#41;&#44; the final result was suboptimal &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B&#44; Video 1&#41;&#46; Given the risk of thrombosis or restenosis&#44; a new procedure was planned for optimization by IVL&#46; A Shockwave&#8482; catheter &#40;3&#46;5 mm&#215;12 mm&#41; was applied for eight cycles of 10 pulses and the stent was successively dilated with a 3&#46;5 mm non-compliant balloon&#46; Despite clear improvement in luminal area&#44; underexpansion assessed by angiography and optical coherence tomography &#40;OCT&#41; persisted &#40;Video 2&#41;&#46; It was therefore decided to apply the 3&#46;5 mm&#215;12 mm Shockwave&#8482; catheter for another eight cycles&#46; Subsequent OCT showed calcium cracking and increased minimum luminal area&#44; without clear evidence of scaffold distortion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A-C&#44; Video 3&#41;&#46; The stent boost image did not clarify the integrity of the device &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D&#41;&#46; A new drug-eluting stent was implanted in the first stent&#44; followed by optimization with a 4&#46;0 mm non-compliant balloon&#44; with a good final result &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A and B&#44; Videos 4 and 5&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">IVL is a new option for the treatment of severe stent underexpansion&#46; It remains to be clarified in future studies whether the best subsequent therapeutic option is stent-in-stent implantation or drug-eluting balloon dilatation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Coronary intravascular lithotripsy and severe stent underexpansion
Litotrícia coronária e sub-expansão grave do stent
Eduardo Arroyo-Úcara,b,
Corresponding author
earroyoucar@gmail.com

Corresponding author.
, Manuela Romero Vazquiáneza,b, Francisco Torres Sauraa,b
a Unidad de Cardiología Intervencionista, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
b Unidad de Cardiología Intervencionista, Hospital Universitario de Torrevieja, Alicante, Spain
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2020.03.002
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