The Unique Role of Intravascular Lithotripsy (IVL) in Debulking the Nodular Calcium in Left Main Coronary Artery Bifurcation

Abstract

Nodular calcium poses a great challenge during coronary intervention. The presence of nodular calcium is associated with poor post-procedural outcomes. Without debulking the nodular calcium, it is extremely difficult to pass the coronary hardwires including the balloons and drug-eluting stents across the lesion. Application of high atmospheric pressure during balloon inflation in the presence of nodular calcium leads to vessel perforation which is a catastrophe during coronary intervention. We report a rare case of nodular calcium in the left main coronary artery bifurcation which was successfully cracked with pulses of intravascular lithotripsy in a 75-year-old male with old anterior wall myocardial infarction. Although rotablation and orbital arthrectomy have a role in modifying calcium nodules in coronary arteries, intravascular lithotripsy was also successful in debulking the nodular calcium in the left main coronary artery bifurcation.