Work

Guidewire Entry Into a Calcific Fracture Causing Stent Underexpansion

Year: 2026

Type: article

Abstract: BACKGROUND: Intravascular lithotripsy (IVL) is a calcium-modification device that delivers acoustic pressure waves to create calcium fractures, thereby improving lesion compliance. IVL-induced fractures achieve larger stent areas than segments without fractures. CASE SUMMARY: We performed percutaneous coronary intervention on an 86-year-old man for a mid-left anterior descending artery lesion with an optical coherence tomography (OCT) calcium score of 4. IVL was selected. Post-IVL OCT confirmed a deep calcium fracture; however, focal stent underexpansion was observed after stent implantation. OCT showed guidewire entry into the IVL-induced fracture, leading to partial stent deployment within the fracture gap and localized underexpansion. DISCUSSION: An IVL-created fracture can become an unintended track for the guidewire and cause focal stent underexpansion. TAKE-HOME MESSAGE: After IVL, confirm the spatial relationship between the fracture and the guidewire, and rewire before stent implantation when necessary.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106962

Authors: Marohito Nakata, Tatsuya Tabata, Toshiya Chinen

Institution: Urasoe General Hospital

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850