Case date: 28 July 2025

Abstract
We present a case of intravascular lithotripsy (IVL) for a 66-year-old male patient with a previous stent implementation and a 70-80% stenosis at the LAD. A 3.50mm IVL catheter was used, delivering a total of 40 pulses to the lesion. The procedure was performed by dr. Amir Aziz Alkatiri, Sp.JP (K), FIHA at RSJPD Harapan Kita. The treatment resulted in significant reductions in stenosis levels, restoring vessel compliance. Additional treatments with a cutting balloon and further stent implementation were utilized. This case highlights the role of IVL in managing complex calcified vascular lesions.

Case Presentation
A 66-year-old male with a medical history of coronary artery disease requiring a previous stent implementation presented with heavy stenosis at the LAD.

IVUS and angiographic imaging revealed severe calcification of around 70-80% stenosis. The lesion was characterized as nodular. 

The intervention was performed by dr. Amir Aziz Alkatiri, Sp.JP (K), FIHA at RSJPD Harapan Kita. After the initial diagnostic angiography and guidewire insertion, a 3.50 mm Sonico-CX IVL catheter was advanced across the lesion. A total of 40 pulses were delivered.

Following the IVL treatment, IVUS and angiographic imaging showed that the % stenosis has been significantly reduced. Additional treatment with a scoring balloon to remove residual stenosis and further stent implementation was performed to ensure maximal long-term vascular health.

Outcome
Overall, the procedure was successful, resulting in fully fractured calcium across the lesions and restored vessel compliance. At follow-up, no post surgical complications were reported.

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 low risk of dissection and 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 diseases.

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.