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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.
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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
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Gardiner R, Muradagha H, Kiernan TJ. Intravascular lithotripsy during percutaneous coronary intervention: current concepts. Expert Rev Cardiovasc Ther 2022; 20:323-338. [PMID: 35466834 DOI: 10.1080/14779072.2022.2069561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Coronary artery calcification (CAC) is commonly encountered by interventional cardiologists. Severe CAC may impair stent delivery or result in stent underexpansion, stent thrombosis and/or in-stent restenosis (ISR). Multiple tools have been developed to help overcome the challenges associated with CAC and improve outcomes for these patients. Intravascular shockwave lithotripsy (IVL) is a novel therapy that uses acoustic pressure waves for the modification of CAC. AREAS COVERED This review discusses the growing body of evidence to support the safety and efficacy of IVL in the setting of de novo severely calcified coronary arteries prior to stenting. We also discuss international real world experience with the coronary IVL system. This includes the use of IVL in the setting of acute coronary syndrome (ACS), ISR and in combination with other tools for calcium modification. EXPERT OPINION IVL is a safe and effective therapy that results in the fracture of coronary calcium and facilitates optimal stent delivery and expansion. Longer term follow up is essential to shed light on the durability and late outcomes of an IVL strategy. Randomised control trials are warranted to compare IVL to alternative methods of calcium modification and to explore further the use of IVL for ACS.
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Affiliation(s)
- Roisin Gardiner
- Department of Cardiology, University Hospital Limerick, St. Nessan's Rd, Dooradoyle, Limerick, Ireland
| | - Hani Muradagha
- Department of Cardiology, University Hospital Limerick, St. Nessan's Rd, Dooradoyle, Limerick, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, St. Nessan's Rd, Dooradoyle, Limerick, Ireland.,University of Limerick, Limerick, Ireland
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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.
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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
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Forero MNT, Daemen J. The Coronary Intravascular Lithotripsy System. Interv Cardiol 2019; 14:174-181. [PMID: 31867065 PMCID: PMC6918618 DOI: 10.15420/icr.2019.18.r1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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] Open
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).
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Affiliation(s)
| | - Joost Daemen
- Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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