Intravascular lithotripsy for optimized percutaneous coronary intervention of a 30-year-old saphenous vein graft: a case report
Ashwin Kumar, Vinyas Shraffi Venkatesh, Boskey PatelAbstract
Background
Intravascular lithotripsy (IVL) is approved for native coronary calcium modification, but data in saphenous vein grafts (SVGs) are scarce.
Case summary
An 87-year-old man with remote coronary artery bypass grafting presented with chest pain and was found to have non–ST-elevation myocardial infarction and new left ventricular dysfunction. Angiography revealed severe multi-vessel disease, with an 80% proximal lesion in a 30-year-old SVG collateralizing multiple territories with new wall motion abnormality. Percutaneous coronary intervention with embolic protection was attempted, but dense circumferential calcification limited balloon expansion. IVL with a 2.5 mm Shockwave balloon delivering 120 pulses allowed intravascular ultrasound passage, successful stent deployment, and satisfactory expansion.
Discussion
This case demonstrates successful off-label IVL use in SVG percutaneous coronary intervention, adding to limited reports and highlighting its potential in challenging revascularization.