Plaque Modification in Severe Coronary Artery Calcification by Lithoplasty (A) Angiography demonstrates a stenotic lesion in the mid right coronary artery,

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Plaque Modification in Severe Coronary Artery Calcification by Lithoplasty (A) Angiography demonstrates a stenotic lesion in the mid right coronary artery, undilatable by standard high-pressure balloon angioplasty (inset, arrowheads). (B) Optical coherence tomography (OCT) cross-sectional (top) and longitudinal (bottom) images acquired before lithoplasty and coregistered to the OCT lens (arrow in A) demonstrate severe near-circumferential calcification (double-headed arrow) in the area of the stenosis. (C) Angiography demonstrates improvement in the area of stenosis after lithoplasty (inset; note the cavitation bubbles generated by lithoplasty [black arrows]). (D) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-lithoplasty and coregistered to the OCT lens (white arrow in C) demonstrate multiple calcium fractures and large acute luminal gain. (E) Angiography demonstrates complete stent expansion with the semicompliant stent balloon (inset) without the need for high-pressure noncompliant balloon inflation. (F) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-stenting and coregistered to the OCT lens (arrow in E) demonstrate further fracture displacement (arrow), with additional increase in the acute area gain (5.17 mm2), resulting in full stent expansion and minimal malapposition. Ziad A. Ali et al. JIMG 2017;10:897-906 2017 American College of Cardiology Foundation