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Sciahbasi et al. Vessel Plus 2023;7:19 https://dx.doi.org/10.20517/2574-1209.2023.22 Page 7 of 12

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).

modification of the culprit lesion during primary PCI. The rate of no-reflow was low (4%), with no cases of
coronary perforation and one case of stent thrombosis. The rate of 30-day MACE was quite high (18%),
mainly due to a high rate of mortality (17%). Anyway, this finding may be explained by the older age and
the higher rate of comorbidity of this cohort of patients.

- Stent under-expansion. Stent under-expansion is a worrisome condition during PCI associated with in-
stent restenosis and mostly stent thrombosis . In this setting, no specific technique or device is effective to
[42]
adequately dilate the under-expanded stent and no consensus exists about the optimal approach to the
treatment of such lesions. In this field, IVL represents a promising resource, with different studies showing
the effectiveness of IVL in the correct treatment of these lesions [Figure 3], even though the procedural
[46]
success is lower than for de-novo lesions [28,43-45] . Among these studies, the CRUNCH registry is the largest,