Matsuda Kazuki, Lee Tetsumin, Ashikaga Takashi, Nozato Toshihiro, Taomoto Yuta, Sasano Tetsuo
Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
JACC Case Rep. 2025 Apr 2;30(7):103381. doi: 10.1016/j.jaccas.2025.103381.
There are no reports in which in-stent restenosis (ISR) lesion treated by intravascular lithotripsy (IVL) is followed by coronary angioscopy examination in addition to coronary angiography and optical coherence tomography.
A 53-year-old man with stable angina underwent drug-eluting stent implantation in the left anterior descending artery lesion with severe calcification 4 years before and an underexpansion remained. Despite high-pressure balloon dilatations with multiple sessions, adequate lumen area could not be obtained. However, we performed revascularization with IVL and excellent stent expansion was achieved. Seven months later, follow-up coronary angiography with optical coherence tomography and coronary angioscopy revealed sustained acute lumen gain with no evidence of stent recoil or ISR.
ISR lesion was successfully treated with IVL and assessed by multimodality imaging.
TAKE-HOME MESSAGE: This case highlights the potential efficacy of IVL for underexpanded ISR lesions with severe calcification.
目前尚无关于血管内碎石术（IVL）治疗支架内再狭窄（ISR）病变后，除冠状动脉造影和光学相干断层扫描外还进行冠状动脉血管内镜检查的报道。
一名53岁稳定型心绞痛男性患者，4年前在左前降支严重钙化病变处植入药物洗脱支架，支架扩张不全。尽管多次进行高压球囊扩张，仍无法获得足够的管腔面积。然而，我们采用IVL进行血运重建，实现了良好的支架扩张。7个月后，随访冠状动脉造影、光学相干断层扫描和冠状动脉血管内镜检查显示持续的急性管腔增加，无支架回缩或ISR迹象。
IVL成功治疗了ISR病变，并通过多模态成像进行了评估。
本病例突出了IVL对严重钙化的扩张不全ISR病变的潜在疗效。
