Case submitted by Antonio Colombo, San Raffaele
Summary: Large eccentric lesion at left circumflex (LCX) ostium; delivered four cycles with 3.5 mm Shockwave IVL catheter; full balloon expansion (and associated lower endoflator pressure) were noted; verified treatment response using a non-compliant balloon; then used the same IVL device to successfully treat the left main (LM).
Case submitted by Jonathan Hill, King’s College
Summary: Unprotected left main (LM) trifurcation with heavy calcium throughout LM, left anterior descending artery (LAD), left circumflex artery (LCX), and at ostia of trifurcation; hemodynamic support with temporary pump; Shockwave IVL administered along LAD, LCX, LM and at the ostia of LCX, LAD, and Ramus; drug-eluting stents (DES) placed in LM and all three vessels with good expansion and apposition (demonstrated with OCT).
Case submitted by Brian Kolski, MD, St. Joseph Hospital
Summary: 85-year-old woman with critical aortic stenosis and severe rest pain. Not a surgical candidate due to lung disease. Calcified near-occlusion of distal aorta and no transcaval or subclavian access option available. 7.0 mm x 60 mm Shockwave IVL delivered to bilateral iliac arteries. Post-IVL safe passage of a 26 mm Medtronic Evolut R TAVR/TAVI device followed by endovascular femoral repair. Patient discharged the following day.
Case submitted by David Caparrelli, MD, Catholic Medical Center
Summary: Pre-procedure angiogram shows extensive calcification and tight stenoses distal to existing AAA graft. 7.0 x 60 mm Shockwave IVL delivered to left iliac artery. Post-IVL angiogram demonstrates suitable access diameter. 24 Fr Medtronic Valiant TEVAR graft safely delivered and deployed through iliac artery with no complications.
Case submitted by Robert Riley, MD, The Christ Hospital
Summary: Baseline angiogram shows extensive iliofemoral calcification in cardiogenic shock patient. Transfemoral delivery of Impella CP attempted, but device won’t advance. Shockwave IVL delivered to iliac artery to fracture calcium. Post-IVL, Impella device advances smoothly through iliac artery.
Case submitted by Thierry Lefevre, Institut Cardiovasculaire Paris Sud
Summary: Nearly occluded right coronary artery (RCA) that was a planned rotablation case; however guidewire went through and 3.0 Shockwave IVL catheter followed and opened up nicely after 40 pulses; once the RCA was open, we realized we undersized and used a 3.5 IVL – all 80 pulses in the two ostial segments; implanted a 3.5 x 18 drug-eluting stent (DES).
