Figure 1.

Angiographic and IVUS Images of Our Patients

Angiography and intravascular ultrasound showed a subtotal occlusion of the right proximal subclavian artery due to mixed atheroma (A and B). Red arrow in (A) pointing to high grade stenosis by angiography; and red arrow in (B) pointing to soft plaque and asterisk depicting calcified plaque component. The lesion was treated by angioplasty and a bare-metal stent with a good result by angiography and IVUS (C and D). With the second patient, angiography demonstrated occlusion of the distal subclavian (E), whereas fluoroscopy revealed massive lesion calcification (F). Red arrows in (F) depicting severe calcification; blue arrow in (F) showing the IVUS catheter. During balloon angioplasty, a “waist” was present, indicating incomplete expansion (G). Red arrows in (G) indicating incomplete expansion of the conventional balloon. Intravascular lithotripsy was therefore used, facilitating better balloon expansion (H) and a good angiographic result after the implantation of a self-expanding bare-metal stent (I). Red arrows in (H) indicating complete expansion of the lithotripsy balloon.