Journal of Cardiology and Heart Failure

ABSTRACT

Severely calcified coronary artery disease poses a substantial technical challenge during Percutaneous Coronary Intervention (PCI), particularly in patients deemed ineligible for surgical revascularization due to multiple comorbidities. We present the case of a 58-year-old male with end-stage renal disease, liver cirrhosis, prior myocardial infarction with in-stent restenosis, and triple-vessel disease involving the left main and bifurcation branches. The patient was refused for CABG by multiple centers and presented with unstable angina. Conventional balloon dilation failed due to severe calcification, and the procedure was aborted due to high perforation risk. Intra Vascular Lithotripsy (IVL) was then employed to safely modify the calcified lesions, enabling successful bifurcation stenting using the double-kissing crush technique. The patient was discharged in stable condition, with complete symptom resolution. This case highlights IVL as a critical and effective tool for lesion preparation in patients with complex calcified anatomy, especially when traditional options are limited or unsafe.

Keywords: Intravascular Lithotripsy; Calcified Coronary Disease; PCI; In-Stent Restenosis; Left Main Bifurcation; CABG-Ineligible; High-Risk Intervention; Case Report