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Post-ACS Antiplatelet Management — EECC MCQ

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HardCoronary Artery DiseasePost-ACS Antiplatelet ManagementEECC

A calcified proximal LAD lesion has been stented after apparently adequate balloon preparation. The stent remains focally underexpanded at 55% despite repeated 24-atm non-compliant balloon inflations. OCT shows deep circumferential calcium behind intact struts. Which adjunct is most appropriate?

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Correct answer: A — Intravascular lithotripsy delivered within the underexpanded stent

Deep circumferential calcium can prevent stent expansion even after high-pressure ballooning. Intravascular lithotripsy can fracture calcium through deployed struts and permit further expansion. Rotational atherectomy risks damaging fresh struts, a second stent compounds underexpansion, and a drug-coated balloon does not modify deep calcium; laser is a specialist alternative but saline-only activation is less effective for this mechanism.

Reference: 2024 ESC Guidelines for chronic coronary syndromes. https://academic.oup.com/eurheartj/article/45/36/3415/7743115