Patient was 80's years old female with chest discomfort during exertion. Laboratory findings showed normal renal function.ECG showed normal, and echocardiography also showed normal LV function and no valvular disorder. 04451627_YOUDAKIKUKO_XA_20220909_1_1_0001.mpg
Chest X-ray showed also normal. 1.mov 2.mov
CAG showed showed 90% stenosis in mid RCA, and CTO in distal #4-PL. Target lesion in current situation was mid RCA with severe calcification. oct1.mov
1. SHOCKWACE 2.5mm/12mm & size up for SHOCKWAVE 3.0mm/12mm was performed with OCT guidance.2. Angiography showed good result but, OCT suggested extraluminal hematoma.3. IVUS was performed, also identified extraluminal hematoma expanding distal RCA. 4. Sion was performed inside hematoma with IVUS guidance. 5. Caravel was introduced inside hematoma to aspirate hematoma. Hematoma was well reduced6. DES was implanted at only culprit site with STRAW technique.7. Final angiography showed no expansion of hematoma. 3.mov 17.mov
IVL is good option for calcified lesion, however, unexpectable complication could be occur. Extraluminal hematoma could be expand far distal and occluded antegrade flow. However, STRAW technique could contribute for management of hematoma in this case.