Management of under-expansion stent using intravascular lithotripsy under OCT guidance: a case report and systematic review.

Under-expansion stent (UES) remains a critical challenge in percutaneous coronary intervention (PCI) for heavily calcified lesions, increasing risks of restenosis and stent thrombosis. Percutaneous intravascular lithotripsy (IVL) is an emerging technique that has demonstrated safety and effectiveness in managing calcified lesions across various clinical studies. However, there remains a lack of consensus on the optimal application of IVL, particularly in cases of UES. We report a case of severe coronary artery calcification (CAC) with localized UES after initial PCI, managed successfully using IVL guided by optical coherence tomography (OCT). The patient underwent multiple IVL treatments, which led to a significant improvement in UES without any adverse events. This case highlights IVL’s role in modifying calcified plaques resistant to conventional therapies, while OCT provides critical insights into calcium morphology and guides tailored IVL delivery. The integration of IVL and OCT offers a precision-based strategy for UES correction in CAC, addressing both mechanical and imaging limitations of traditional approaches. Further studies are warranted to standardize IVL protocols for UES in complex calcified disease.