Case date: 24 September 2025

Abstract
We present a case of intravascular lithotripsy (IVL) in a 63-year-old female patient with hypertension and a history of stroke. The patient presented heavy calcification across the LAD. A 3.00mm IVL catheter was used, delivering a total of 90 pulses throughout the LAD. The procedure was performed by dr. Muhammad Yolandi Sumadio Sp. JP(K) and dr. Faisal Habib, Sp.JP(K), FIHA at RSUP Adam Malik. The treatment resulted in a significant reduction in stenosis levels across multiple lesion sites. Additional drug-coated balloon treatment across the lesion site was utilized. This case highlights the role of IVL in managing complex calcified vascular lesions.

Case Presentation
A 63-year-old female with a medical history of stroke and hypertension.

Diagnostic IVUS imaging revealed heavy calcification throughout the LAD. The calcification was characterized as concentric, with multiple segments showing around 270-360° calcification.

The intervention was performed by Dr. dr. Muhammad Yolandi Sumadio Sp. JP(K) and dr. Faisal Habib, Sp.JP(K), FIHA at RS Adam Malik. After the initial IVUS imaging, an IVL catheter with a 3.00 mm diameter was advanced across the lesion. A total of 90 pulses were delivered across three lesion sites.

Following the use of IVL, adjunctive treatment with a drug-coated balloon (DCB) was performed.

Outcome
The procedure was successful, resulting in significant reductions in stenosis levels to well below 20%. 

Discussion
This case demonstrates the effectiveness of IVL in treating heavily calcified coronary lesions.

Compared to conventional lesion modification strategies such as rotational atherectomy or cutting balloons, IVL provides controlled calcium disruption, low risk of dissection and ease of use.

In this patient, IVL allowed successful vessel preparation and facilitated subsequent drug-coated balloon (DCB) deployment. Our experience supports the role of IVL as a valuable tool in managing complex calcified disease, particularly in patients with other pre-existing medical histories, in this case hypertension and stroke. 

Conclusion
Intravascular lithotripsy is a safe and effective method for modifying vascular calcium and optimizing outcomes in patients with complex calcified lesions. This case highlights its potential role as a frontline therapy in selected patients.