Successful use of lithoplasty for re-expansion of covered iliac stents with unilateral occlusion

Abstract

Vessel wall calcification is associated with stent under-expansion and in-stent restenosis. The traditional approaches to treat peripheral artery calcification are percutaneous transluminal angioplasty (PTA) and atherectomy. Shockwave intravascular lithotripsy (IVL) uses sonic wave pressure to disrupt calcium of the severely calcified lesions. Published reports of IVL to treat in-stent restenosis are limited to coronary interventions and bare metal platforms.MethodsWe describe the case of a 55-year-old male with extremely compressed under-expanded covered stents associated with severe wall calcification that resulted in stent occlusion.ResultsThe IVL system balloon was deployed uneventfully, in a phased manner. Bilateral bare metal stents were also placed in a kissing fashion to further re-expand the arterial segments. Reintervention with IVL facilitated successful revascularization and the stent remained patent at 24 months.ConclusionOur case highlights the use of IVL as an effective tool in the management of vessel wall calcification both for primary and secondary interventions.

Keywords: Calcification; angioplasty; covered stent; in-stent restenosis; peripheral artery disease; shockwave intravascular lithotripsy.