Coronary intravascular lithotripsy for coronary artery calcifications- systematic review of cases

Intravascular lithotripsy for coronary calcium: A case report and review of the literature

BACKGROUND

Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events. Aggressive balloon post-dilatation though helpful is usually inadequate. Multiple plaque ablation techniques are in vogue, but they are technically demanding and are not without complications. Shockwave intravascular lithotripsy (S-IVL) has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin. A series of trials (DISRUPT CAD I-IV) have demonstrated both short-term and long-term safety and efficacy of the technique. As experience with the technique grows more and more, therapy areas like stent restenosis are being covered by the S-IVL.

CASE SUMMARY

We report a series of 2 cases successfully managed with S-IVL therapy at our center. The first case is of a 57-year-old smoker who presented with acute coronary syndrome. His left anterior descending coronary artery revealed calcified 90% stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging. The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted. The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram. She also demonstrated a mixture of superficial and deep seated calcium zones on imaging. S-IVL therapy was applied to generate fractures in calcium, and two overlapping drug-eluting stents were implanted successfully without any complications.

CONCLUSION

S-IVL is an emerging, efficient, user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.

One-year outcomes in patients who underwent coronary intravascular shockwave lithotripsy for highly-calcified coronary lesions

Intravascular lithotripsy (IVL) is associated with excellent angiographic and short-term results in patients with calcified lesions requiring percutaneous coronary intervention. We conducted a 1-year follow up of a retrospective cohort of 47 patients (61 lesions) who underwent IVL. The primary outcome was target vessel revascularization (TVR) at 1-year from index procedure. Four percent of patients required TVR within 1 year; 96% who underwent IVL remained free from repeat intervention on the same vessel. One patient suffered a myocardial infarction; the culprit vessel had not been previously treated with IVL. IVL is an effective and durable modality for treatment of highly calcified coronary lesions in high-risk patients.