Intracoronary Lithotripsy: A New Solution for Undilatable In-Stent Chronic Total Occlusions

Abstract Percutaneous coronary intervention was performed in a flush in-stent right coronary artery chronic total occlusion. Successful retrograde recanalization was performed but the lesion was balloon undilatable as confirmed by intravascular ultrasound. High-pressure post-dilation with noncompliant and plaque modification balloons failed, but intravascular lithotripsy successfully expanded the lesion. (Level of Difficulty: Advanced.)