Treatment of coronary in-stent restenosis (ISR) is challenging and often requires combination of multiple treatment modalities. Coronary intravascular lithotripsy (IVL) has been successfully used for treating stent under-expansion, but is not currently commercially available in the United States. We present three recurrent coronary ISR cases in which multiple treatment modalities (high-pressure balloon inflation, plaque modification balloons, and laser with contrast injection) failed. These patients were treated with a combination of IVL (peripheral IVL catheter used off-label in the coronary arteries) and brachytherapy. Due to the high IVL balloon profile, delivery via femoral or radial access was challenging, requiring 7–8 French guide catheters. IVL was performed delivering 4–8 treatments of 20 pulses each with a favorable final angiographic and intravascular ultrasound result. All patients were angina free 1 month after the procedure.
- coronary restenosis
- percutaneous coronary intervention
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine