1
|
Umeh CA, Kaur H, Paknoosh S, Ganjian B, Samreen I, Rainee K, Cheng M, Rastogi A, Gupta R. Intravascular lithotripsy in coronary arteries: a review of case reports. Egypt Heart J 2024; 76:121. [PMID: 39243292 PMCID: PMC11380655 DOI: 10.1186/s43044-024-00555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Calcified coronary arteries encountered during percutaneous intervention increase the probability of unsuccessful procedures. Heavy calcification of coronary arteries may lead to suboptimal stent expansion. Intravascular lithotripsy (IVL) is a novel method of transmitting sonic waves in pulses, which fractures the calcific plaque in the vessel with minimal soft tissue injury. This study systematically reviews and summarizes the reported clinical scenarios in which IVL was successfully used in coronary lesions. MAIN TEXT Articles were obtained by searching PubMed and Embase databases for IVL use in coronary arteries. We restricted the search to case reports. Our study included 84 patients from 70 case reports/case series. The mean age was 70.3 years (SD 10) and ranged from 27 to 96 years, and 67% were males. The indications for the angiogram that led to the use of IVL include chest pain (37.7%), non-ST elevated myocardial infarction (27.9%), ST elevated myocardial infarction (13.1%), and previous under-expanded stent (8.2%). The IVL was used in the left anterior descending artery (60.7%), right coronary artery (35.7%), left main disease (23.8%), and left circumflex (9.5%). Coronary IVL was safely and successfully used in different clinical scenarios for heavily calcified coronary lesions, including in-stent restenosis of native coronary arteries, saphenous vein grafts, and under-expanded stents. In addition, IVL was successfully used synergistically with orbital and rotational atherectomy and drug-coated balloon angioplasty in select patients. CONCLUSION IVL has successfully been used in an expanding array of clinical scenarios.
Collapse
Affiliation(s)
- Chukwuemeka A Umeh
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA.
- St. George's University School of Medicine, West Indies, Grenada.
| | - Harpreet Kaur
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
| | - Sean Paknoosh
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
| | - Benjamin Ganjian
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
| | - Isha Samreen
- Department of Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA, 92543, USA
| | | | - Mindy Cheng
- Department of Emergency Medicine, Hemet Global Medical Center, Hemet, CA, USA
| | - Anisha Rastogi
- Division of Cardiology, Hemet Global Medical Center, Hemet, CA, USA
| | - Rahul Gupta
- Department of Internal Medicine, University of California, San Diego, CA, 92122, USA
| |
Collapse
|
2
|
Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Fujita H. Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification. Cardiovasc Interv Ther 2023; 38:375-380. [PMID: 37542662 DOI: 10.1007/s12928-023-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
The concept of lifetime management has not been discussed in the field of percutaneous coronary intervention (PCI), because the durability of drug-eluting stent (DES) is considered to be long enough for most patients. Furthermore, even if in-stent restenosis occurs, the treatment for in-stent restenosis is simple in most cases. On the other hand, the long-term clinical outcomes after DES implantation are worse in severely calcified coronary lesions than in non-calcified lesions. Moreover, the treatment for in-stent calcified restenosis or restenosis due to stent underexpansion is not simple. The concept of lifetime management of severely calcified lesions may be necessary like that of aortic stenosis. Recently, several algorithms have been published in PCI to severely calcified lesions, partly because of the emergence of IVL. These algorithms focus on the selection of cracking and debulking devices for the preparation of stenting. However, the optimal stent expansion does not guarantee the long-term patency, when the target lesion includes calcified nodules. Stent restenosis due to calcified nodules is difficult to manage. In this review article, we propose the algorithm for severely calcified lesions focused on the shape of calcification. We do not need to hesitate stenting when multiple cracks on circumferential calcification are observed by intravascular imaging devices. However, DCB may be an option as final device in some situations, when lifetime management of severely calcified lesions is considered.
Collapse
Affiliation(s)
- Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| |
Collapse
|
3
|
Sasi V, Szántó G, Achim A, Ungi I, Varga A, Ruzsa Z. Combination of Laser Atherectomy and Super High-pressure Non-compliant Balloon to Treat Stent Under-expansion in Cases of Failed Interventional Options. Interv Cardiol 2023; 18:e23. [PMID: 37538386 PMCID: PMC10394584 DOI: 10.15420/icr.2022.36] [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] [Received: 11/06/2022] [Accepted: 04/23/2023] [Indexed: 08/05/2023] Open
Abstract
Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain. The authors report on a patient with prior numerous right coronary unsuccessful coronary interventions resulting in partially crushed multiple layers of stent material with critical lumen narrowing caused by stent under-expansion. Balloon angioplasty and stent rotational atherectomy (ROTA) had been attempted to overcome stent under-expansion but were unsuccessful. The authors investigated a new combination therapy of laser atherectomy (ELCA) and super high-pressure balloon (OPN non-compliant balloon) to treat single or multiple layers of stent with severe under-expansion due to fibrotic, calcified tissue surrounding the under-expanded stent structure.
Collapse
Affiliation(s)
- Viktor Sasi
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Gyula Szántó
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Alexandru Achim
- Department of Interventional Cardiology, Medicala 1 Clinic, Iuliu Hațieganu University of Medicine and PharmacyCluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital BasellandLiestal, Switzerland
| | - Imre Ungi
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Albert Varga
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Zoltán Ruzsa
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| |
Collapse
|
4
|
Włodarczak A, Rola P, Barycki M, Kulczycki JJ, Szudrowicz M, Lesiak M, Doroszko A. Rota-Lithotripsy-A Novel Bail-Out Strategy for Calcified Coronary Lesions in Acute Coronary Syndrome. The First-in-Man Experience. J Clin Med 2021; 10:1872. [PMID: 33925916 PMCID: PMC8123389 DOI: 10.3390/jcm10091872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed a rota-lithotripsy-a combination of rotational atherectomy with subsequent intravascular lithotripsy-as a novel bail-out strategy to facilitate stent delivery in a tortuous calcified coronary artery.
Collapse
Affiliation(s)
- Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland;
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital in Legnica, 59-220 Legnica, Poland;
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland; (A.W.); (J.J.K.); (M.S.)
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-491 Poznan, Poland;
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| |
Collapse
|