Case date: 8 August 2025

Abstract
We present a case of intravascular lithotripsy (IVL) in a 49-year-old male with a history of hypertension and severe diabetes. The patient presented with 60% stenosis across the whole length of the LAD. A 2.50mm IVL catheter was used, delivering a total of 120 pulses throughout the LAD. The procedure was performed by Dr. dr. Chandramin Ch, Sp.JP, Subsp. KI (K) at RS Premier Bintaro. The treatment resulted in a significant reduction in stenosis levels across multiple lesion sites. Additional stent implementation across three lesions sites was utilized. This case highlights the role of IVL in managing complex calcified vascular lesions.

Case Presentation
A 49-year-old male with a medical history of severe diabetes, requiring amputation of a leg and hypertension.

Diagnostic imaging revealed 40-60% stenosis in the mid RCA, heavy calcification throughout the LAD around 40-60% stenosis and 50-70% stenosis in the proximal section of the LCX. For the usage of IVL to treat the stenosis, the LAD was prioritized to be treated first.

The intervention was performed by Dr. dr. Chandramin Ch, Sp.JP, Subsp. KI (K) at RS Premier Bintaro. After an initial 1.50 mm NC balloon was used to open up the vessel, a 2.50 mm Sonico-CX IVL catheter was advanced across the lesion. A total of 120 pulses were delivered.

Following IVL, there was a significant reduction in stenosis levels wherever IVL pulses were delivered. Additional treatment with stent implementation at three different sites was performed, finalizing the whole procedure. 

Outcome
At follow-up, the patient remained symptom-free, with improved cardiovascular health.

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, ease of use.

In this patient, IVL allowed successful vessel preparation and facilitated subsequent stent deployment. Our experience supports the role of IVL as a valuable tool in managing complex calcified disease, particularly in patients with a history of diabetes and hypertension.

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.