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Published in: Journal of Cardiothoracic Surgery 1/2024

Open Access 04-05-2024 | Myocardial Disease | Case Report

Extension of interval between adjacent pulse delivery cycles to deal with myocardial ischemia by intravascular lithotripsy: case report

Authors: He Lv, Xinyu Li, Zengduoji Ren, Zhilu Qin, Chunying Fu, Qiang Fu

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

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Abstract

Background

Intravascular lithotripsy (IVL) represents a novel approach in the management of coronary calcification. This technique employs acoustic pressure waves, generated by a shockwave balloon, to effectively fracture both superficial and deep calcification in situ. The efficacy and safety of IVL have been convincingly demonstrated through the Disrupt CAD I-IV studies. While IVL is associated with the occurrence of atrial and ventricular arrhythmias, there is no evidence to indicate it causes myocardial ischemia.

Case Description

A 71-year-old man was admitted presenting with chest pain. His previous coronary angiography revealed stenosis and calcification in the left anterior descending branch. An attempt to predilate the lesion using two Lacrosse non-slip element balloons was unsuccessful. Ventricular premature beats and transient ST-segment depression were captured during the utilization of IVL. The operator gradually extended the pulse emission interval across two consecutive cycles to mitigate myocardial ischemia. Notably, when the interval reached 30s, the patient had no chest pain or ST-segment changes. Subsequent images of intravascular ultrasound confirmed calcification ruptures. Therapeutic intervention included the placement of a stent and the application of a drug-coated balloon in the left anterior descending branch. A telephonic follow-up six months later indicated the patient had no discomfort.

Conclusions

This case underscores the effectiveness of gradually extending the pulse emission interval as a strategic complement to the clinical application of IVL. In certain clinical scenarios, it may become imperative to suspend the pulse delivery to improve myocardial blood supply.
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Literature
Metadata
Title
Extension of interval between adjacent pulse delivery cycles to deal with myocardial ischemia by intravascular lithotripsy: case report
Authors
He Lv
Xinyu Li
Zengduoji Ren
Zhilu Qin
Chunying Fu
Qiang Fu
Publication date
04-05-2024
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-02782-z

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