fig1

Figure 1. Shockwave in a de-novo undilatable lesion. A heavily calcified lesion on the left anterior descending (A) has been treated by multiple pre-dilatation using non-compliant balloons (2.0 mm × 15 mm and 2.25 mm × 15 mm, NC Quantum Apex, inflated up to 20 atmospheres) without effective lesion dilatation and a “dog bone” effect (B). Five cycles of 10 pulses of intravascular lithotripsy with a 2.5 mm × 12 mm expanded up to 6 atmospheres (C) obtained a successful dilatation of the lesion. The procedure has been completed with 2 drug eluting stents (2.25 mm × 32 mm and 2.5 mm × 12 mm, Synergy, Boston) with a good final result (D).