Lithoplasty-assisted transfemoral aortic valve implantation.

An 85-year-old man with previous left anterior descending (LAD) and left circumflex (LCX) stenting and low left ventricular ejection fraction (35%) developed acute pulmonary oedema because of severe aortic valve stenosis (0.7 cm). Computed tomography showed bilateral calcific atheromas of both external iliac arteries with circumferential thick calcium plates restricting the lumen diameter to 4.1 mm. The case was refused for surgery and initially discarded for transcatheter aortic valve implantation (TAVI) because of poor vascular access. After a new episode of pulmonary oedema refractory to medical treatment and requiring ultrafiltration, a transfemoral TAVI was attempted. The calcified stenosis of the right external iliac artery was dilated with a 7.0 mm lithoplasty balloon (Shockwave Medical, Fremont, CA, USA). After six lithotripsy erogations, there was good balloon expansion at low pressure (4–6 atm). Gentle twist and push over a Confida wire drove the 18-Fr delivery system of a 29 mm Evolut-R Medtronic valve through the narrowest segment of the iliac artery. After valve