Lithotripsy for calcified in-stent restenosis. The "rock strata peeling pattern": A novel fracture pattern detected by optical coherence tomography

Catheter Cardiovasc Interv. 2022 Nov;100(6):1036-1038. doi: 10.1002/ccd.30420. Epub 2022 Oct 13.


Calcified neoatherosclerosis represents a particularly challenging scenario in patients with in-stent restenosis (ISR), frequently associated with worse angiographic and optical coherence tomography (OCT) results compared with other patients with typical ISR. Intravascular lithotripsy (IVL) has emerged as a safe and effective technology to circumferentially modify calcium in heavily calcified coronary lesions. Preliminary data also suggest its usefulness in calcified neoatheroscerosis. This case report aims to describe a novel fracture pattern after IVL identified by OCT (the "rock strata peeling pattern") in patients presenting with ISR due to calcified neoatherosclerosis.

Keywords: coronary artery disease; in-stent restenosis; intravascular lithotripsy; percutaneous coronary intervention.

Publication types

  • Case Reports

MeSH terms

  • Constriction, Pathologic
  • Coronary Angiography
  • Coronary Restenosis* / diagnostic imaging
  • Coronary Restenosis* / etiology
  • Coronary Restenosis* / therapy
  • Humans
  • Lithotripsy* / methods
  • Percutaneous Coronary Intervention* / adverse effects
  • Tomography, Optical Coherence / methods
  • Treatment Outcome