fig2

Figure 2. Shockwave for the treatment of an unexpanded coronary stent. A heavily calcified lesion on the circumflex artery (A) has been treated by multiple pre-dilatation using non-compliant balloons (2.5 mm × 15 mm and 3 mm × 15 mm, NC Quantum Apex, inflated up to 16 atmospheres). Then a drug eluting stent (B) was implanted (3.5 mm × 24 mm, Synergy Boston, expanded up to 20 atmospheres) without satisfactory expansion (C and D). Despite multiple post-dilatation using non-compliant balloons (4.0 mm × 12 mm and 4.5 mm × 12 mm, NC Quantum, Boston, inflated up to 18 atmospheres), the stent remained under-expanded (E). Six cycles of 10 pulses of intravascular lithotripsy with a 3.5 mm × 12 mm expanded up to 6 atmospheres (F) obtained a successful dilatation of the lesion (G).