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Page 16 of 22 Andò et al. Vessel Plus 2023;7:15 https://dx.doi.org/10.20517/2574-1209.2023.26
Figure 4. Percutaneous revascularization of the calcific lesion shown in Figure 2B. In (A), baseline angiography shows a significant
stenosis in proximal LAD (arrow). In (B), IVUS interrogation shows a concentric ring calcification. In (C), calcium fractures are evident
at IVUS after Intravascular Lithotripsy and high-pressure non-compliant balloon dilatation. In (D), vessel lumen enlargement and
optimal stent apposition are evident at IVUS. In (E) final angiographic result is shown.
Figure 5. Percutaneous revascularization of the calcific lesion shown in Figure 1. In (A), baseline angiography is shown. After Rotational
Atherectomy (B), incomplete expansion of a non-compliant balloon is evident at conventional angiography (C) and after using stent-
enhancement features (D). After Intravascular Lithotripsy, optimal balloon expansion is confirmed along the entire calcified stenotic
segment (E and F). Final result after stent optimization is shown with stent-enhancement features (G) and conventional angiography
(H).
vessel lumen with IVUS [Figure 4]. The key maneuver, however, is the confirmation of the optimal
expansion of a non-compliant balloon [Figure 5], of a 1:1 sizing with the target vessel (“balloon testing” or
“lesion palpation”), ideally with two orthogonal views, preparatory to stent implantation; alternatively, the
