Abstract

Introduction: Dense coronary artery calcification is still a problem. Current options available include coronary atherectomy or cutting balloons of various styles. However, none of them confers promising results. These treatments are either in-effective or complex, with much higher rates of morbidity. A novel treatment option-Cardiac Shock Wave Therapy has been developed and shows very promising results. Case Report: We report here a case of patient with complex and heavily calcified coronary artery disease. A 71 years gentleman with known case of diabetes mellitus and hypertension presented with chest pain and was diagnosed as NSTEMI in June 2018. His coronary angiogram revealed short left main stem. Left anterior descending was severely atherosclerotic and ecstatic with long proximal aneurysmal segment without any flow limiting stenosis. Left circumflex shows severely diffuse atheroma. Small early OM1 branch with 90% discrete stenosis. Right coronary artery was large, dominant vessel with severe diffuse calcification. Ostial 90% stenosis followed by large aneurysmal segment. Post aneurysm 80% proximal stenosis. Further 90% mid vessel stenosis. Diffuse distal disease. In view of complex and heavily calcified coronaries he was turned down for PCI by interventional cardiologist and was also not considered for CABG as there was a real risk of graft failure because of competitive flow in native coronaries. He was treated with optimal medical therapy. He represented with recurrent angina despite been on optimal antianginal medications. We did perform cardiac shock wave therapy (CSWT- PCI) Pre- dilatation followed by deployment of drug eluting stent in RCA with excellent result. Conclusion: In conclusion, cardiac shock wave therapy has now becoming the preferred way and is a new non-invasive therapy for densely calcified coronary artery lesion which usually is not amenable for stenting who suffers from myocardial infarction who had no or little chance of revascularisation. Promising result noted in DISRUPT-I and DISRUPT- II trial.