Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


Background: Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Here we report the Novo combination of Shockwave Lithotripsy after Orbital Atherectomy.

Case: An 81-year-old man was admitted for hemodynamically stable NSTEMI. He had a past medical history of AF, HT, DM, COPD, hepatitis B cirrhosis, and moderate-severe aortic stenosis. Coronary angiogram showed heavily calcified LM and TVD. He was stratified as a high risk CABG candidate. We proceeded high-risk PCI to RCA first.

Decision-making: Optical coherence tomography (OCT) was performed to the RCA. At the minimal luminal area (MLA), there was circumferential thick calcification, with area of 1.55 mm2. IVL was performed but failed to open up the heavily calcified mid-RCA lesion. With absence of significant dissection from OCT, OA was performed at low and high-speed. The lesion at MLA was successfully cracked with luminal gain to 2.23 mm2 from 1.55 mm2. However, the luminal size at the MLA was still quite small with reference to the vessel size, and the calcium remained very thick even after multiple arthrectomies. Hence, IVL was performed again. After Orbital-Tripsy, very significant luminal gain was observed with angiogram and OCT. Ostial to mid-distal RCA was stented with 2 overlapping drug-eluting stents.

Conclusion: OA can effectively debulk calcium to facilitate further lesion cracking with IVL, which was demonstrated to be safe and synergistic to each other, attaining stepwise gain in luminal area [Formula presented]





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