Intravascular Laser Lithotripsy - A Novel Modality for the Management of Severely Calcified Coronary Lesions: A Literature Review and Clinical Case Report

Abstract

Objective: To present a clinical case of successful application of intravascular laser lithotripsy (IVL) in a patient with circular calcification of the left anterior descending artery (LAD).
Materials and methods: A case of a 53-year-old man with severe coronary calcification who underwent percutaneous coronary intervention using the FastWave IVL system is described.
Results: In a patient with severe circumferential calcification of the left anterior descending artery, intravascular laser lithotripsy (IVL) resulted in significant fragmentation of calcium deposits, as confirmed by intravascular ultrasound. The procedure resulted in effective artery dilation and successful implantation of three stents with adequate expansion (95–98%) and tight adherence to the vessel wall. There were no periprocedural complications. The total procedure duration was 120 minutes, with a radiation dose of 4658 Gy cm² and a contrast agent volume of 250 ml. Morphological changes recorded by IVUS before and after the procedure indicate a significant increase in the minimum lumen area (up to 10.79 mm² in the proximal segment) and a decrease in the degree of stenosis to <20%.
Conclusions: This clinical case demonstrates the high efficacy and safety of intravascular laser lithotripsy in the treatment of severe circumferential coronary calcification. IVL allowed for adequate modification of the calcified plaque and provided optimal conditions for stenting without complications. This method can be considered a preferred alternative to rotational atherectomy in patients with complex anatomical lesions and a high risk of complications. These data highlight the potential of IVL as a new tool in the interventional cardiologist’s arsenal for improving clinical outcomes in complex forms of coronary artery disease.
Annotation: Coronary calcification is a significant challenge in interventional cardiology, complicating stent delivery and deployment and increasing the risk of complications during percutaneous coronary interventions (PCI). Traditional methods of calcified plaque modification, such as rotational atherectomy and cutting balloons, have limitations, including the risk of distal embolization and incomplete stent deployment [13]. Intravascular laser lithotripsy (IVL) is an innovative treatment for calcified lesions. The method uses shock waves to selectively destroy calcium deposits with minimal soft tissue damage [8]. The procedure ensured effective calcium destruction, optimal stent deployment, and the absence of periprocedural complications [5]. The results highlight the clinical significance of IVL as a safe and effective method capable of improving PCI outcomes in patients with calcified lesions [1]. This experience demonstrates the potential of IVL to change the standard of care for complex coronary lesions, providing cardiologists with a new tool to improve procedural success and patient prognosis.