Implementation of Javelin Shockwave IVL Treatment for Lesion Preparation of Heavily Calcified Right Coronary Artery in Inferior STEMI

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Coronary artery calcification adds considerable challenge to PCI, limiting the effectiveness of balloon angioplasty and hindering stent delivery and expansion.

Case: 82-year-old female with past medical history of peripheral artery disease presented with a vasovagal episode, substernal chest discomfort and shortness of breath. ECG showed ST elevations in leads II, III and avF and Mobitz-1 AV block. She underwent emergent coronary angiogram which showed a severely calcified right coronary artery (RCA) with discrete occlusion within the mid segment and no significant disease in the left coronary system. The mid-RCA culprit lesion was crossed with a Minamo wire resulting in TIMI-3 flow, however there was repeated difficulty delivering equipment distal to the heavily calcified lesion despite utilization of microcatheters. During this time, the patient experienced intermittent complete heart block and re-occlusion of the culprit lesion with inferior ST-elevations. Decision was made to implement off-label use of the Javelin intravascular lithotripsy (IVL) catheter with 8 sequential treatments of the mid-to-distal RCA. Following this, a non-compliant balloon was able to be delivered and subsequently a shockwave balloon, and ultimately a 2.75 x 38 mm drug-eluting stent. Following post-dilation, there was TIMI-3 flow and intravascular ultrasound demonstrated appropriate stent opposition and a minimal stent area of 5.0 mm2. Post PCI echocardiogram showed normal LVEF and mild basal inferior hypokinesis.

Decision-Making: The shockwave Javelin IVL catheter is a novel, non-balloon method to modify heavily calcified lesions predominantly used in peripheral interventions, which we implemented in a case of inferior STEMI. Data from the DISRUPT CAD III study showed implementation of IVL for lesion preparation prior to stent implantation to be both safe and effective. In our case, the use of IVL facilitated delivery of required equipment in a clinically tenuous inferior STEMI where conventional methods were unsuccessful.

Conclusion: Our case highlights the implementation of an IVL catheter to modify and deliver definitive equipment in a heavily calcified inferior STEMI culprit lesion.

Volume

87

Issue

13 Suppl

First Page

A1614

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1615

DOI

doi:10.1016/j.jacc.2026.02.4040

ISSN

0735-1097

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