1
|
Coronary lithotripsy - a state of the art review. Trends Cardiovasc Med 2022; 33:215-222. [PMID: 35045278 DOI: 10.1016/j.tcm.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022]
Abstract
Lesion calcification is frequently encountered during percutaneous coronary intervention and has been directly linked to procedural complications and future cardiac events. Intravascular lithotripsy is a novel balloon-based modality that does not rely on barotrauma or debulking, but converts electrical energy into mechanical energy creating sonic pressure waves that selectively disrupt calcium. The present review provides an overview of its mechanism of action, the available evidence on its safety and efficacy and indications for use.
Collapse
|
2
|
Finnegan P, Jefferies J, Margey R, Hennigan B. Coronary lithotripsy: a novel approach to intra-coronary calcification with 'cracking' results? THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:21. [PMID: 35747090 PMCID: PMC9205228 DOI: 10.5837/bjc.2020.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Coronary lithotripsy is a novel approach to percutaneous coronary intervention (PCI). It is based on well-established technology dating back to 1980 when lithotripsy was first used to treat renal calculi. Its application in cardiovascular medicine is a more recent development that involves using a low-pressure lithotripsy balloon to deliver unfocused acoustic pulse waves in a circumferential mechanical energy distribution. This causes fracturing of calcification within the surrounding vasculature, facilitating optimal stent deployment. This article aims to review recent clinical experience and the published data regarding intravascular lithotripsy (IVL). All relevant articles were identified via PubMed using keywords including "intravascular lithotripsy", "shockwave" and "coronary". All studies that contained published datasets regarding IVL with patient numbers >50 were included for review. There were 116 results found. After reviewing all the publications, articles were then tabulated and 17 were found to be relevant, including only four clinical studies. In this review we found that intracoronary lithotripsy for heavily calcified arteries appears to be a safe, effective, easy-to-use method of dealing with an otherwise technically-challenging and high-risk scenario. It appears to carry low risk, uses low pressures, and exerts its effects on both superficial and deep intravascular calcium. Further prospective data with long-term follow-up will be required to explore both the off-label uses of IVL (such as post-stent dilatation), and the long-term patency of these vessels.
Collapse
Affiliation(s)
- Paula Finnegan
- Resident Medical Officer, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - John Jefferies
- Resident Medical Officer, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - Ronan Margey
- Consultant Interventional Cardiologist, and Senior Clinical Lecturer, University College Cork, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| | - Barry Hennigan
- Consultant Interventional Cardiologist, and Senior Clinical Lecturer, University College Cork, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland
| |
Collapse
|
3
|
Intracoronary Lithoplasty in Percutaneous Treatment of Challenging Calcified Coronary Lesions. JACC Case Rep 2020; 2:1679-1683. [PMID: 34317033 PMCID: PMC8312044 DOI: 10.1016/j.jaccas.2020.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unexpanded stents in calcified coronary stenosis is a problem where intravascular lithotripsy could be effectively employed. In these 2 cases, we report possible issues associated with the use of this technology. (Level of Difficulty: Intermediate.)
Collapse
|
4
|
Kassimis G, Didagelos M, De Maria GL, Kontogiannis N, Karamasis GV, Katsikis A, Sularz A, Karvounis H, Kanonidis I, Krokidis M, Ziakas A, Banning AP. Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification. Angiology 2020; 71:677-688. [PMID: 32567327 DOI: 10.1177/0003319720932455] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.
Collapse
Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.,1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS, Foundation Trust, Cheltenham, United Kingdom
| | | | - Athanasios Katsikis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Agata Sularz
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- 2nd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
5
|
Venuti G, Piedimonte G, Castellana C, Ferrarotto L, Guarracini S, Azzalini L, Manna AL. Using the coronary lithotripsy system for coronary artery disease. Future Cardiol 2020; 17:59-71. [PMID: 32530304 DOI: 10.2217/fca-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Severe coronary artery calcification increases percutaneous treatment complexity and the risk of intraprocedural complications, affecting acute and long-term outcomes. Current use of specialty balloons and atherectomy technologies is limited due to the higher risk of complications, degree of technical difficulty and operator experience. Intravascular lithotripsy (IVL) is a novel technology for severe calcified coronary artery disease that facilitates vessel preparation, enhancing vessel compliance. IVL system emits sonic waves that penetrate through vascular layers and disrupt both superficial and deep calcium, leaving the soft tissue unharmed. The purpose of the present review is to provide a summary of the evidence currently available on this therapy, including a practical description of the components and function of the shockwave coronary IVL system.
Collapse
Affiliation(s)
- Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Giulio Piedimonte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Carmelo Castellana
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | | | - Lorenzo Azzalini
- The Zena & Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| |
Collapse
|
6
|
Forero MNT, Daemen J. The Coronary Intravascular Lithotripsy System. ACTA ACUST UNITED AC 2019; 14:174-181. [PMID: 31867065 PMCID: PMC6918618 DOI: 10.15420/icr.2019.18.r1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
Calcified lesions often mean percutaneous intervention results are suboptimal and increase the risk of procedural complications and future adverse events. Available plaque-modifying devices rely on tissue compression or debulking, with the intention of fracturing calcium and facilitating optimal stent deployment. In contrast, coronary intravascular lithotripsy delivers unfocused, circumferential, pulsatile mechanical energy to safely disrupt the calcium within the target lesion. The present review summarises the evidence available so far on this therapy and includes a practical description of the components and function of the Shockwave Intravascular Lithotripsy System (Shockwave Medical).
Collapse
Affiliation(s)
| | - Joost Daemen
- Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| |
Collapse
|
7
|
Feasibility of kissing balloon technique through guide extension catheters: an experimental bench test. Cardiovasc Interv Ther 2019; 35:269-275. [PMID: 31541392 DOI: 10.1007/s12928-019-00622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/11/2019] [Indexed: 11/27/2022]
Abstract
Previous reports showed that GuideLiner (GL) and Guidezilla (GZ) can accommodate bulky and multiple devices beyond the official profiles. However, feasibility of kissing balloon technique (KBT) through these devices is unknown. The tested devices included 7Fr-GL/GZ and respective three types of 2.5 mm semi-compliant (SC) and non-compliant (NC) balloons: conventional model (CM), tapered-tip model (TM) and latest model (LM). First, three experienced operators attempted to advance all 21 combinations of the 2 balloons through GL/GZ on the guidewires and assessed the crossability in 3 grades: easy, difficult and impossible. Second, the only balloon combinations graded as easy by all operators were tested in the polyurethane-made bifurcation model which required KBT following cross-over stenting. Within the total of 42 device combinations, only one balloon combination of double LM-NC balloons was classified as easy in both GL/GZ by consensus opinion of the operators. While two combinations of LM-SC and LM-SC/NC balloons were classified as difficult in both GL/GZ, all four combinations of LM-SC/NC and CM/TM-NC balloons were classified as difficult only in GL. Other 32 combinations were all classified as impossible. In the bifurcation model, the combination of double LM-NC balloons using GL achieved KBT while the same balloon combination with GZ failed. The feasibility of KBT using child-catheter is highly dependent on the device characteristics. The combination of latest small-profile NC balloons through GL could be clinically applicable.
Collapse
|