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Vol. 73. Issue 7.
Pages 577 (July 2020)
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Vol. 73. Issue 7.
Pages 577 (July 2020)
Image in cardiology
DOI: 10.1016/j.rec.2019.10.013
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Deep circumferential calcium fracture after coronary lithotripsy
Fractura de calcio circunferencial profundo tras litotricia coronaria
Santiago Jesús Camacho Freire
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Corresponding author:
, Antonio Enrique Gómez Menchero, José Francisco Díaz Fernández
Servicio de Cardiología, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
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A 71-year-old male exsmoker with hypertension, diabetes and dyslipidemia was admitted for unstable angina. Angiography showed a severe long and calcified lesion from the left main coronary artery to the proximal and medial left anterior descending (LAD) artery. Figure 1 (video 1 of the supplementary data) shows the optical coherence tomography (OCT) image acquired before coronary lithotripsy (CL). Severe circumferential calcification was observed in the proximal LAD lesion (* guidewire artefact), with an OCT-calcium score of 4. This score is a predictor of inadequate expansion (maximum calcium thickness> 0.5mm,> 180°, length>5mm). Angioplasty was performed by CL (shockwave intravascular lithotripsy) with a 3×12mm balloon at 4atm for 10seconds, applying 2 pulses to the medial LAD artery and 1 to the proximal LAD artery (balloon rupture occurred on opening of the proximal lesions at 6 atm; nominal diameter/vessel ratio=0.9). Figure 1B (video 2 of the supplementary data) shows the outcome immediately after CL at the same point of the proximal LAD. Complete fractures of the circumferential calcium with a depth of up to 1.4mm (arrows) can be seen. These had no impact on the adventitia of the vessel. Plaque preparation was completed by predilatation with a cutting balloon (3×10mm) and, under OCT imaging guidance, 2 overlapping drug-eluting stents were implanted. Figure 1C (video 3 of the supplementary data) shows the follow-up OCT image after stent placement. Displacement of the fractures can be seen with acute luminal gain, enabling appropriate stent expansion and minimal residual malapposition.

Figure 1
Appendix A

Supplementary data associated with this article can be found in the online version available at

Appendix B


Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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