Intravascular lithotripsy as a treatment option for recalcitrant in-stent restenosis in symptomatic patients with chronic iliofemoral venous obstruction.

Reinterventions after stenting for chronic iliofemoral venous obstruction have an incidence of approximately 20% to 40% in the literature. The most common reason for this tends to be in-stent restenosis (ISR). Although angioplasty historically has been the modality used to treat this problem, at times ISR can be robust and associated with calcium deposits, leading to an inadequate outcome. Although newer debulking devices like the RevCore can be helpful, sometimes even these devices are not adequate given their inability to secure a foothold on the fibrotic tissue to enable its removal. Using an intravascular lithotripsy catheter (12 mm) helps to soften the fibrotic tissue and fracture the calcium deposits, thus enabling angioplasty or a debulking device (if needed) to be successful. This case series outlines the author's experience with three patients with recalcitrant ISR who benefited from using an intravascular lithotripsy catheter that enabled prolonged symptom improvement and stent patency over a follow-up of 19 months. However, the use of such a catheter for the treatment of venous ISR represents an off-label use of the device.