Occlusive coral reef aortic plaque treated with intravascular lithotripsy and kissing iliac stents

Aortoiliac occlusive disease is a common cause of claudication symptoms. When complicated by extensive calcification, successful angioplasty and resolution of symptoms may be difficult to achieve. Several plaque-modifying therapies have been developed, but most existing treatment modalities have no significant effect on deep, medial calcified plaque. Intravascular lithotripsy (IVL) has emerged as a safe and effective means of addressing highly calcified occlusive lesions. We present a case of bilateral disabling claudication in a patient with diminished femoral pulses due to a large occlusive distal aortic coral reef plaque. This was successfully treated with bilateral aortoiliac lithotripsy, followed by balloon-expandable covered stent placement. The patient had full resolution of his claudication symptoms. We review and summarize the literature on IVL as a viable treatment modality for aortoiliac and peripheral arterial occlusive disease.