Figure 1.

Staged Intravascular Lithotripsy-Facilitated Stent Deployment in STEMI

(A) A 65-year-old woman presented with inferior STEMI. Heart rate = 70 beats/min and blood pressure = 110/60 mm Hg. (B) High-pressure noncompliant balloon inflation failed to dilate the severely calcified culprit lesion (arrowheads). TIMI flow grade 3 was achieved, and stenting was deferred. (C) At a staged procedure, a 3 × 12-mm IVL balloon was inflated (4 atm) and 3 cycles of IVL delivered. Post-IVL, full balloon inflation was noted. (D) Post-IVL IVUS revealed multiple fractures in the concentric calcification (arrows). (E) A 3 × 23-mm drug-eluting stent was implanted and post-dilated with a 3.5 × 20-mm noncompliant balloon (at 22 atm). Final angiography revealed optimal stent expansion and TIMI flow grade 3. (F) IVUS MSA = 7.9 mm². No slow-flow/no-reflow, arrhythmia, or hemodynamic compromise were noted during the staged procedure. Ca = calcium; IVL = intravascular lithotripsy; IVUS = intravascular ultrasound; MSA = minimal stent area; NC = noncompliant; TIMI = Thrombolysis In Myocardial Infarction.