1145 BAIL-OUT INTRAVASCULAR CORONARY LITHOTRIPSY FOR THE TREATMENT OF STENT IN-STENT UNDER EXPANSION

Abstract Background in-stent restenosis remains a significant clinical problem for which optimal treatment is under debate. Intravascular lithotripsy (IVL) mostly used safe and effective of de novo coronary calcifications, while the use this technology to support bailout procedures, including stent under-expansion, still off-label. One advantages possible after deployment. Case presentation 66-year-old male patient was admitted our Institution due medically refractory angina computed tomography (CCT) detecting three vessel disease with multiple critical stenosis. The had comorbidities history hypertension, dyslipidemia, type 2 diabetes myocardial rivascularization. In 2003 he underwent artery by-pass (CABG) left internal mammal (LIMA) anterior descending (LAD) free saphenous vein graft (VG) ramus intermedius (RI). 2009 percutaneous intervention (PCI) right (RCA) implantation at central segment, second crux cordis. For recurrent previously implanted segment treated in 2013 balloon angioplasty (POBA) 2017 another drug eluting (Resolute Onyx, Medtronic, Santa Rosa, California) overlapping proximal part scaffold. Coronary angiography revealed, severe 80% stenosis distal main. LAD occluded middle presented 99% segment. RCA diffuse involving Resolute Onyx stent. Therefore, operator decided treat direct stenting (Xience, Abbott Vascular Clara, USA), but unaware fact that there already an barely visible. After implantation, inadequate expansion stents observed (Figura 1A-B), persisted despite post-dilation non-compliant (NCB) high-pressure (Figure 1C). Given persistence it perform bail-out intravascular therapy Shockwave catheter 2A). then post-dilated NCB 2B). final angiographic image ultrasound (IVUS) showed 3). Conclusion could be undilatable stent-in-stent restenosis. Of interest, case demonstrated, first time, IVL 2-stent layers, optima expansion.