The dilemma of repeat in-stent restenosis: Can intravascular lithotripsy provide an alternative approach to an age-old problem?

In-stent restenosis (ISR) has always been considered a conundrum for interventional cardiologists. Despite many technical advances in the past 20 years aimed at reducing its occurrence, this area of interventional cardiology remains challenging. Here, we present a novel use of intravascular lithotripsy therapy (IVL) in a patient with repeat ISR, in whom IVL treatment has provided excellent procedural and follow-up results. Here, we present a 79-year-old man with previous ISR to a left circumflex artery (LCX) stent presenting with angina. An elective coronary angiogram confirmed recurrent ISR in the LCX. This was treated by IVL, which provided an excellent procedural result. The patient made an uneventful recovery and was discharged the same day with a follow-up 90 days postprocedure, at which point they were asymptomatic from angina. IVL is a relatively simple technique to modify ISR with a short learning curve. This case presentation highlights a novel use of IVL in a subclass of patients that remains challenging for the interventional cardiology community.