A case of acute pericarditis developing early after intravascular lithotripsy for a severely calcified coronary lesion

Post-cardiac injury syndrome (PCIS) is an inflammatory condition triggered by pericardial or myocardial injury, even when the preceding trauma is minimal. Intravascular lithotripsy (IVL) has demonstrated a favorable safety profile in treating heavily calcified coronary lesions; however, rare complications may occur. An 89-year-old man previously underwent percutaneous coronary intervention (PCI) for a left main bifurcation lesion using the T and small protrusion technique. Follow-up angiography revealed disease involving both the left anterior descending and left circumflex arteries. IVL was performed for lesion preparation, after which intravascular ultrasound demonstrated subepicardial hematoma formation. Shortly after the procedure, the patient developed pleuritic chest pain accompanied by diffuse ST-segment elevation and elevation of inflammatory markers and cardiac troponin. Based on the clinical presentation, electrocardiographic findings, and laboratory results, a diagnosis of PCIS was established. Symptoms and inflammatory abnormalities resolved promptly with nonsteroidal anti-inflammatory therapy. We report a rare case of PCIS that developed after the use of IVL for a calcified coronary lesion.