PMC8084382_01
A. Subtotal occlusion of the ostial right coronary artery (RCA) with tortuous uptake from the aorta; B. Angiographic appearance of the Shockwave intravascular lithotripsy (IVL) balloon; C. Final angiographic result after stent implantation; D-F. Intravascular ultrasound (IVUS) before IVL revealing three-to-four-quadrant (270  to 360 ) calcification of the proximal RCA along with severe ostial stenosis; D'-F'. IVUS after IVL demonstrating successful fracture of the calcified lesion within proximal RCA; D"-F". Final IVUS showing optimal stent expansion.
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Fig. 1A). Following intubation with a 7F AL 0.75 guiding catheter, and sequential high-pressure predilatation (1.2 mm semi-compliant balloon, and 2.0 mm to 3.0 mm non-compliant balloons), intravascular ultrasound (IVUS) revealed extensive three-to-four-quadrant (270  to 360 ) calcification within proximal RCA along with persistent ostial stenosis of the vessel (Fig. 1D-F). To modify plaque within proximal RCA, a 4.0 x 12 mm intravascular lithotripsy (IVL) balloon was inflated to 4 atm, and 8 cycles of 10 pulses each were delivered, followed by further dilatation to nominal pressure (Fig. 1B). IVUS after IVL confirmed multiple calcium disruptions (Fig. 1D'-F') allowing for guideliner-facilitated delivery and deployment of 2 drug eluting stents (4.0 mm each), and further high-pressure postdilatation (at 22 atm) using a 4.5 non-compliant balloon. Optimal angiographic result (Fig. 1C) was subsequently verified with both IVUS (Fig. 1D"-F"; Suppl.