{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:51:47Z","timestamp":1781675507122,"version":"3.54.5"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Coral reef aorta (CRA) is defined by the presence of heavily calcified exophytic plaques that protrude into the aortic lumen. Open surgery remains the standard treatment but is associated with substantial morbidity, particularly in high-risk patients. Endovascular approaches, including intravascular lithotripsy (IVL), have emerged as less invasive alternatives. This case series aimed to evaluate the feasibility, safety, and hemodynamic impact of IVL combined with fractional flow reserve (FFR) in the treatment of calcified aortic stenoses. We present a case series of three patients with severe calcified abdominal aortic stenosis treated with IVL under FFR guidance. Pre- and post-procedural FFR measurements were used to assess lesion hemodynamic significance and treatment efficacy. All procedures were technically successful, with significant improvement in FFR values following IVL, indicating restoration of hemodynamic flow. One case was complicated by an aortic dissection, successfully managed with stent placement. In the remaining cases, IVL achieved adequate luminal gain without the need for stenting. At follow-up (up to 12\u00a0months), all patients demonstrated sustained clinical improvement and maintained vessel patency. IVL combined with FFR appears to be a feasible and effective minimally invasive approach for the management of heavily calcified aortic lesions. This strategy allows both morphological plaque modification and objective physiological assessment, potentially reducing the need for stent implantation. Larger studies are required to validate these findings.<\/jats:p>","DOI":"10.1186\/s42155-026-00698-4","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:58:10Z","timestamp":1781672290000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intravascular lithotripsy for coral reef aortic stenosis: a case series assessing feasibility, hemodynamic effects, imaging and clinical outcomes"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0565-5408","authenticated-orcid":false,"given":"Marios Platon","family":"Dimopoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3717-117X","authenticated-orcid":false,"given":"Maria","family":"Papageorgiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2245-499X","authenticated-orcid":false,"given":"Georgios","family":"Nistikoulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-2068","authenticated-orcid":false,"given":"Panagiotis","family":"Kitrou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5950-8472","authenticated-orcid":false,"given":"Dimitrios","family":"Karnabatidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6312-1836","authenticated-orcid":false,"given":"Konstantinos","family":"Katsanos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"698_CR1","doi-asserted-by":"publisher","DOI":"10.1177\/15266028251333680","author":"KP Donas","year":"2025","unstructured":"Donas KP, Pitoulias AG, Kapetanios D, Lehmann R, Avranas K. IVUS-assisted intravascular lithotripsy for the treatment of a paravisceral coral reef aorta with a new large-diameter balloon catheter: case report. J Endovasc Ther. 2025. https:\/\/doi.org\/10.1177\/15266028251333680.\u00a0","journal-title":"J Endovasc Ther"},{"issue":"1","key":"698_CR2","volume":"17","author":"R Borioni","year":"2025","unstructured":"Borioni R, Rinaldi Garofalo A, Tesori MC, Salerno A, Gentile PA. Stentless intravascular lithotripsy for the paravisceral coral reef aorta: a case report. Cureus. 2025;17(1):e77123.","journal-title":"Cureus"},{"key":"698_CR3","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ejvsvf.2025.04.003","volume":"64","author":"N Troisi","year":"2025","unstructured":"Troisi N, Pierozzi S, Berchiolli R. Waves across the coral reef aorta: intravascular lithotripsy in juxtarenal aortic occlusive disease. EJVES Vasc Forum. 2025;64:28\u201331. https:\/\/doi.org\/10.1016\/j.ejvsvf.2025.04.003.","journal-title":"EJVES Vasc Forum"},{"key":"698_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejvsvf.2024.02.002","volume":"63","author":"F Elger","year":"2024","unstructured":"Elger F, Secer R, Silvano M, Grambow E, Torsello GF, Torsello GB. IVUS-guided intravascular lithotripsy of the juxtarenal and visceral coral reef aorta. EJVES Vasc Forum. 2024;63:1\u20134. https:\/\/doi.org\/10.1016\/j.ejvsvf.2024.02.002.","journal-title":"EJVES Vasc Forum"},{"key":"698_CR5","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a001234","author":"DF Elger","year":"2026","unstructured":"Elger DF, et al. Intravascular lithotripsy-enhanced treatment of paravisceral coral reef aorta. Vasa. 2026. https:\/\/doi.org\/10.1024\/0301-1526\/a001234.","journal-title":"Vasa"},{"issue":"12","key":"698_CR6","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.99086","volume":"17","author":"T Charalambous","year":"2025","unstructured":"Charalambous T, Sousamlis F, Katsantouris G, Gerardos E, Zannes N. Intravascular lithotripsy for suprarenal coral reef aorta: a novel endovascular approach to complex calcified disease. Cureus. 2025;17(12):e99086. https:\/\/doi.org\/10.7759\/cureus.99086.","journal-title":"Cureus"},{"key":"698_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/diabetology7030057","volume":"7","author":"W Zasada","year":"2026","unstructured":"Zasada W, Bobrowska B, Krawczyk-O\u017c\u00f3g A, Rakowski T, Bartus\u0301 S, Dziewierz A, et al. Diabetes-related differences in the predictive value of the physiological assessment of myocardial ischemia for long-term clinical outcomes. Diabetology. 2026;7:57. https:\/\/doi.org\/10.3390\/diabetology7030057.","journal-title":"Diabetology"},{"issue":"1","key":"698_CR8","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/j.1540-8183.2011.00691.x","volume":"25","author":"AS Lotfi","year":"2012","unstructured":"Lotfi AS, Sivalingam SK, Giugliano GR, Ashraf J, Visintainer P. Use of fraction flow reserve to predict changes over time in management of superficial femoral artery. J Interv Cardiol. 2012;25(1):71\u20137. https:\/\/doi.org\/10.1111\/j.1540-8183.2011.00691.x.","journal-title":"J Interv Cardiol"},{"issue":"2","key":"698_CR9","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.ejvs.2023.07.035","volume":"67","author":"MA Albayati","year":"2024","unstructured":"Albayati MA, Patel A, Modi B, Saha P, Karim L, Perera D, et al. Intra-arterial fractional flow reserve measurements provide an objective assessment of the functional significance of peripheral arterial stenoses. Eur J Vasc Endovasc Surg. 2024;67(2):332\u201340. https:\/\/doi.org\/10.1016\/j.ejvs.2023.07.035.","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"4","key":"698_CR10","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.4445","volume":"11","author":"MA Mangi","year":"2019","unstructured":"Mangi MA, Kahloon R, Elzanaty A, Zafrullah F, Eltahawy E. The use of fractional flow reserve for physiological assessment of indeterminate lesions in peripheral artery disease. Cureus. 2019;11(4):e4445. https:\/\/doi.org\/10.7759\/cureus.4445.","journal-title":"Cureus"},{"issue":"4","key":"698_CR11","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1067\/mva.1993.40228","volume":"17","author":"DA Legemate","year":"1993","unstructured":"Legemate DA, Teeuwen C, Hoeneveld H, Eikelboom BC. How can the assessment of the hemodynamic significance of aortoiliac arterial stenosis by duplex scanning be improved? A comparative study with intraarterial pressure measurement. J Vasc Surg. 1993;17(4):676\u201384. https:\/\/doi.org\/10.1067\/mva.1993.40228.","journal-title":"J Vasc Surg"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00698-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00698-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00698-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:58:11Z","timestamp":1781672291000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00698-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["698"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00698-4","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"assertion":[{"value":"17 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with institutional policies. Due to the retrospective nature of this case series, formal ethics committee approval was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of anonymized clinical data and imaging material was obtained from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"74"}}