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Sagris M, Ktenopoulos N, Soulaidopoulos S, Dimitriadis K, Papanikolaou A, Tzoumas A, Terentes-Printzios D, Lichtenberg M, Korosoglou G, Toutouzas K, Honton B, Tousoulis D, Tsioufis K. Intravascular lithotripsy in peripheral lesions with severe calcification and its use in TAVI procedure - a meta-analysis. VASA 2024; 53:263-274. [PMID: 38934125 DOI: 10.1024/0301-1526/a001133] [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] [Indexed: 06/28/2024]
Abstract
Background: Heavily calcified peripheral artery lesions increase the risk of vascular complications, constituting a severe challenge for the operator during catheter-based cardiovascular interventions. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and represents a promising technique for plaque modification in patients with severe calcification in peripheral arteries. Purpose: Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified peripheral arteries and its use in Transcatheter Aortic Valve Implantation (TAVI). Patients and methods: This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL in the peripheral vasculature. The diameter of the vessel lumen before and after IVL was estimated. The occurrence of peri-procedural complications was assessed using a random-effects model. Results: 20 studies with a total of 1,223 patients with heavily calcified peripheral lesions were analysed. The mean age of the cohort was 70.6 ± 17.4 years. Successful IVL delivery achieved in 100% (95% CI: 100%-100%, I2 = 0%), with an increase in the luminal diameter (SMD: 4.66, 95% CI: 3.41-5.92, I2 = 90.8%) and reduction in diameter stenosis (SMD: -4.15, 95% CI: -4.75 to -3.55, I2 = 92.8%), and a concomitant low rate of complications. The procedure was free from dissection in 97% (95% CI: 91%-100%, I2 = 81.4%) while dissections of any type (A, B, C, or D) were observed in 6% (95% CI: 2%-10%, I2 = 85.3%) of the patients. Several rare cases of abrupt closure, no-reflow phenomenon, perforation, thrombus formation, and distal embolization were recorded. Finally, the subgroup analysis of patients who underwent a TAVI with IVL assistance presented successful implantation in 100% (95% CI: 100%-100%, I2 = 0%) of the cases, with only 4% (95% CI: 0%-12%, I2 = 68.96%) presenting dissections of any sort. Conclusions: IVL seems to be an effective and safe technique for modifying severely calcified lesions in peripheral arteries and it is a promising modality in TAVI settings. Future prospective studies are needed to validate our results.
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Affiliation(s)
- Marios Sagris
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Ktenopoulos
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Stergios Soulaidopoulos
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Angelos Papanikolaou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas Tzoumas
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Dimitrios Terentes-Printzios
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital, Weinheim, Germany
| | - Konstantinos Toutouzas
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Dimitris Tousoulis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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2
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Nobile E, Piscione M, Cammalleri V, Gaudio D, Antonelli G, De Luca VM, Carpenito M, Cocco N, Nusca A, Ussia GP. Controlled mitral valvuloplasty using steerable catheter- waist- formed balloon system: A clinical case series. Catheter Cardiovasc Interv 2024. [PMID: 38922752 DOI: 10.1002/ccd.31127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/26/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
As the general population ages, the incidence of degenerative mitral stenosis (MS) among patients has increased. Percutaneous mitral valvuloplasty (PMV) has emerged as a well-established option for mitral rheumatic stenosis with specific characteristics. However, a blank therapeutic space must be filled with the treatment options for degenerative or rheumatic mitral stenosis in patients with many comorbidities and contraindication for valvuloplasty. We here present a comprehensive overview of the current possibilities, despite their scarce success. That is the reason why we propose a case series to facilitate a better understanding of our innovative technique in this challenging clinical context.
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Affiliation(s)
- E Nobile
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - M Piscione
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - V Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - D Gaudio
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - G Antonelli
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - V M De Luca
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - M Carpenito
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - N Cocco
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - A Nusca
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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3
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Fan CH, Tsai CY, Lai CY, Liou YF, Lee JK, Yeh CK. Feasibility of in vitro calcification plaque disruption using ultrasound-induced microbubble inertial cavitation. ULTRASONICS 2024; 138:107238. [PMID: 38183758 DOI: 10.1016/j.ultras.2023.107238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) is a clinical method in which plaque-narrowed arteries are widened by inflating an intravascular balloon catheter. However, PTCA remains challenging to apply in calcified plaques since the high pressure required for achieving a therapeutic outcome can result in balloon rupture, vessel rupture, and intimal dissection. To address the problem with PTCA, we hypothesized that a calcified plaque can be disrupted by microbubbles (MBs) inertial cavitation induced by ultrasound (US). This study proposed a columnar US transducer with a novel design to generate inertial cavitation at the lesion site. Experiments were carried out using tubular calcification phantom to mimic calcified plaques. After different parameters of US + MBs treatment (four types of MBs concentration, five types of cycle number, and three types of insonication duration; n = 4 in each group), inflation experiments were performed to examine the efficacy of cavitation for a clinically used balloon catheter. Finally, micro-CT was used to investigate changes in the internal structure of the tubular plaster phantoms. The inflation threshold of the untreated tubular plaster phantoms was > 11 atm, and this was significantly reduced to 7.4 ± 0.7 atm (p = 5.2E-08) using US-induced MBs inertial cavitation at a treatment duration of 20 min with an acoustic pressure of 214 kPa, an MBs concentration of 4.0 × 108 MBs/mL, a cycle number of 100 cycles, and a pulse repetition frequency of 100 Hz. Moreover, micro-CT revealed internal damage in the tubular calcification phantom, demonstrating that US-induced MBs inertial cavitation can effectively disrupt calcified plaques and reduce the inflation threshold of PTCA. The ex vivo histopathology results showed that the endothelium of pig blood vessels remained intact after the treatment. In summary, the results show that US-induced MBs inertial cavitation can markedly reduce the inflation threshold in PTCA without damaging blood vessel endothelia, indicating the potential of the proposed treatment method.
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Affiliation(s)
- Ching-Hsiang Fan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan
| | - Chieh-Yu Tsai
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Chun-Yen Lai
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Ya-Fu Liou
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10617, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan.
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4
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Lv H, Li X, Ren Z, Ma X, Qin Z, Fu Q. Intravascular lithotripsy: A novel option for severe calcification of coronary artery. Clin Cardiol 2024; 47:e24186. [PMID: 37945548 PMCID: PMC10826240 DOI: 10.1002/clc.24186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Severe coronary artery calcification is associated with low success rate of interventional operation, perioperative adverse cardiac events, and poor prognosis, which is a major problem faced by operators. The existing therapy methods all have inherent limitations, such as unsatisfactory balloon crossability, inadequate balloon dilation, and so on. The emergence of intravascular lithotripsy (IVL) has brought the dawn of the treatment of calcified lesions by using unfocused acoustic pressure waves to fracture calcification in situ. And IVL is the only technology capable of targeting deep calcification. HYPOTHESIS IVL may have great clinical application values and potential prospects. METHOD Based on the existing clinical evidence of IVL and traditional treatment ways, this review discusses the safety and efficacy of IVL. Combined with clinical practice, the precautions and coping strategies of IVL are analyzed. And the review improves the management algorithm of coronary calcification. RESULTS IVL has extremely high safety and effectiveness for severe coronary calcification compared with other ways, and structural improvements of IVL will further expand its value. CONCLUSIONS The emergence of IVL could set off a revolution in the treatment of coronary artery calcification.
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Affiliation(s)
- He Lv
- Department of CardiologyThe People's Hospital of China Medical UniversityShenyang CityLiaoning ProvincePeople's Republic of China
| | - Xinyu Li
- Department of CardiologyThe People's Hospital of China Medical UniversityShenyang CityLiaoning ProvincePeople's Republic of China
| | - Zengduoji Ren
- Department of CardiologyThe People's Hospital of China Medical UniversityShenyang CityLiaoning ProvincePeople's Republic of China
| | - Xuelian Ma
- Department of CardiologyJinzhou Medical UniversityJinzhou CityLiaoning ProvincePeople's Republic of China
| | - Zhilu Qin
- Department of CardiologyThe People's Hospital of China Medical UniversityShenyang CityLiaoning ProvincePeople's Republic of China
| | - Qiang Fu
- Department of Cardiology, The Fourth Affiliated Hospital of China Medical UniversityThe People's Hospital of China Medical UniversityShenyang CityLiaoning ProvincePeople's Republic of China
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Servais AB, Meredith DM, Gravereaux EC, Belkin M. Hydrophilic polymer embolization after intravascular lithotripsy. J Vasc Surg 2023; 78:539. [PMID: 37481279 DOI: 10.1016/j.jvs.2022.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 07/24/2023]
Affiliation(s)
- Andrew B Servais
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA
| | - David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Edwin C Gravereaux
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA.
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6
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Latanich CA, Anderson JA. Shockwave Intravascular Lithotripsy Facilitated Transvenous Lead Extraction. JACC Clin Electrophysiol 2023; 9:1585-1592. [PMID: 37278685 DOI: 10.1016/j.jacep.2023.05.007] [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: 04/07/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Dense calcifications encasing pacing leads with long dwell times are common and increase the difficulty of and risks associated with transvenous lead extraction procedures (TLE). Shockwave intravascular lithotripsy (IVL) focuses sound waves to fracture calcified tissue within a narrow radius to the catheter. OBJECTIVES This study sought to assess the impact of Shockwave IVL pretreatment during extraction of long dwell time pacemaker and defibrillator leads. METHODS Data were compiled retrospectively from patients undergoing TLE at Essentia Health in Duluth, Minnesota, from October 2019 to April 2023. IVL pretreatment was performed using currently available 7- and 8-mm balloons with ≤300 pulses delivered in close proximity to the leads via a retrograde approach, after which the procedure was completed as usual. RESULTS Of the 120 patients undergoing TLE procedures, 55 were excluded from the study because the leads were freely mobile. Among the remaining 65 patients, 14 received IVL pretreatment. The median patient ages were similar at 67 (IQR: 63-76) years, with a lead dwell time of 10.7 (IQR: 6.9-14.9) years. The frequencies of diabetes, stroke, prior sternotomy, and lead types were not significantly different between the IVL and conventional groups. IVL pretreatment resulted in an average of 25 (IQR: 9-42) fewer minutes actively extracting leads (P = 0.007). CONCLUSIONS These data represent the first known cases using Shockwave IVL as an adjunctive measure during extraction of high-risk and high-complexity leads, with a resulting significant reduction in the amount of time spent engaging in the highest-risk phase of the procedure.
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Affiliation(s)
- Christopher A Latanich
- Heart and Vascular Institute, Department of Medicine, Essentia Health, Duluth, Minnesota, USA.
| | - John A Anderson
- Heart and Vascular Institute, Department of Medicine, Essentia Health, Duluth, Minnesota, USA
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7
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Zuo P, Xu R, Hu L, Hu W, Tong S. Association between monocyte lymphocyte ratio and abdominal aortic calcification in US adults: A cross-sectional study. Clinics (Sao Paulo) 2023; 78:100232. [PMID: 37364352 DOI: 10.1016/j.clinsp.2023.100232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/09/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the association between Monocyte Lymphocyte Ratio (MLR) and Abdominal Aortic Calcification (AAC) in adults over 40 years of age in the United States. METHODS Data were collected from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). AAC was quantified by the Kauppila score system based on dual-energy X-Ray absorptiometry. Severe AAC was defined as a total AAC score > 6. The lymphocyte count and monocyte count can be directly obtained from laboratory data files. Multivariable logistic regression models were used to determine the association between MLR and the AAC score and severe AAC. RESULTS A total of 3,045 participants were included in the present study. After adjusting for multiple covariates, MLR was positively associated with higher AAC score (β = 0.21, 95% CI 0.07, 0.34, p = 0.0032) and the odds of severe AAC increased by 14% per 0.1 unit increase in the MLR (OR = 1.14, 95% CI 1.00, 1.31, p = 0.0541). The Odds Ratio (OR) (95% CI) of severe AAC for participants in MLR tertile 3 was 1.88 (1.02, 3.47) compared with those in tertile 1 (p for trend = 0.0341). Subgroup analyses showed that a stronger association was detected in the elderly compared with non-elderly (p for interaction = 0.0346) and diabetes compared with non-diabetes (borderline significant p for interaction = 0.0578). CONCLUSION In adults in the United States, MLR was associated with higher AAC scores and a higher probability of severe AAC. MLR may become a promising tool to predict the risk of AAC.
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Affiliation(s)
- Peiyuan Zuo
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ranran Xu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liya Hu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Hu
- Department of Pediatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Tong
- Department of Thoracic Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, China.
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Rola P, Kulczycki JJ, Barycki M, Włodarczak S, Furtan Ł, Kędzierska M, Giniewicz K, Doroszko A, Lesiak M, Włodarczak A. Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes. J Clin Med 2023; 12:4025. [PMID: 37373718 DOI: 10.3390/jcm12124025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. METHODS we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. RESULTS The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26-36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26-33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). CONCLUSION OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | | | | | - Adrian Doroszko
- Clinical Department of Internal Medicine and Occupational Diseases, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
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Scalamogna M, Abdel-Wahab M, Mashayekhi K, Fusaro M, Leistner DM, Ayoub M, Xhepa E, Joner M, Kastrati A, Cassese S, Rheude T. Randomized ComparIson of Strategies to PrepAre SeveRely CALCified Coronary Lesions 2: Design and Rationale of the ISAR-CALC 2 Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 49:22-27. [PMID: 36609101 DOI: 10.1016/j.carrev.2022.12.008] [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: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The percutaneous treatment of severely calcified coronary lesions has been associated with lower performance of coronary stents and poor clinical long-term outcomes. Adequate lesion preparation before stent implantation is of paramount importance to minimize the risk of stent failure. Balloon-based techniques for lesion preparation have been the subject of numerous investigations, albeit comparative data from randomized trials are scarce. STUDY DESIGN AND OBJECTIVES The ISAR-CALC 2 (ClinicalTrials.gov: NCT05072730) is an investigator-initiated, prospective, randomized, multicentre, assessors-blind, open-label trial designed to compare a lesion preparation strategy with either super high-pressure balloon or intravascular lithotripsy (IVL) before drug-eluting stent (DES) implantation in patients with severely calcified, undilatable coronary lesions. In total, 80 patients are required for trial completion. The primary endpoint will be final angiographic minimal lumen diameter (MLD) after stent implantation. Key secondary endpoints include stent expansion assessed by optical coherence tomography (OCT), procedural and strategy success, need for complementary lesion preparation with rotational atherectomy, acute lumen gain, and major adverse cardiac events up to 30-day follow-up. CONCLUSIONS The ISAR-CALC 2 trial aims to demonstrate the superiority of a lesion preparation strategy with a super high-pressure balloon as compared with intravascular lithotripsy prior to DES implantation in patients with severely calcified undilatable coronary lesions.
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Affiliation(s)
- Maria Scalamogna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Kambis Mashayekhi
- Klinik für Innere Medizin und Kardiologie, Herzzentrum Lahr, Germany
| | - Massimiliano Fusaro
- Klinik für Kardiologie und Angiologie, Zollernalb Klinikum, Albstadt, Germany
| | - David M Leistner
- Medizinische Klinik 3 - Kardiologie, Angiologie, Universitätsklinikum Frankfurt/Main, Frankfurt, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt, Germany
| | - Mohamed Ayoub
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Mousa MAA, Bingen BO, Al Amri I, Mertens BJA, Taha S, Tohamy A, Youssef A, Jukema JW, Montero-Cabezas JM. Efficacy and Safety of Intravascular Lithotripsy Versus Rotational Atherectomy in Balloon-Crossable Heavily Calcified Coronary Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:1-6. [PMID: 36336588 DOI: 10.1016/j.carrev.2022.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Mohamed A A Mousa
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - B J A Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Salma Taha
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Aly Tohamy
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - Amr Youssef
- Department of Cardiology, Assiut University Heart Hospital, Assiut, Egypt
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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11
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Pan W, Jie W, Huang H. Vascular calcification: Molecular mechanisms and therapeutic interventions. MedComm (Beijing) 2023; 4:e200. [PMID: 36620697 PMCID: PMC9811665 DOI: 10.1002/mco2.200] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
Vascular calcification (VC) is recognized as a pathological vascular disorder associated with various diseases, such as atherosclerosis, hypertension, aortic valve stenosis, coronary artery disease, diabetes mellitus, as well as chronic kidney disease. Therefore, it is a life-threatening state for human health. There were several studies targeting mechanisms of VC that revealed the importance of vascular smooth muscle cells transdifferentiating, phosphorous and calcium milieu, as well as matrix vesicles on the progress of VC. However, the underlying molecular mechanisms of VC need to be elucidated. Though there is no acknowledged effective therapeutic strategy to reverse or cure VC clinically, recent evidence has proved that VC is not a passive irreversible comorbidity but an active process regulated by many factors. Some available approaches targeting the underlying molecular mechanism provide promising prospects for the therapy of VC. This review aims to summarize the novel findings on molecular mechanisms and therapeutic interventions of VC, including the role of inflammatory responses, endoplasmic reticulum stress, mitochondrial dysfunction, iron homeostasis, metabolic imbalance, and some related signaling pathways on VC progression. We also conclude some recent studies on controversial interventions in the clinical practice of VC, such as calcium channel blockers, renin-angiotensin system inhibitions, statins, bisphosphonates, denosumab, vitamins, and ion conditioning agents.
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Affiliation(s)
- Wei Pan
- Department of Cardiology, the Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenGuangdongChina,Joint Laboratory of Guangdong‐Hong Kong‐Macao Universities for Nutritional Metabolism and Precise Prevention and Control of Major Chronic DiseaseSun Yat‐sen UniversityShenzhenGuangdongChina
| | - Wei Jie
- Department of Cardiology, the Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenGuangdongChina,Joint Laboratory of Guangdong‐Hong Kong‐Macao Universities for Nutritional Metabolism and Precise Prevention and Control of Major Chronic DiseaseSun Yat‐sen UniversityShenzhenGuangdongChina
| | - Hui Huang
- Department of Cardiology, the Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenGuangdongChina,Joint Laboratory of Guangdong‐Hong Kong‐Macao Universities for Nutritional Metabolism and Precise Prevention and Control of Major Chronic DiseaseSun Yat‐sen UniversityShenzhenGuangdongChina
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Vancampenhout Y, Kerselaers L, Aerden D, Gallala S, Debing E. Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report. Vasc Endovascular Surg 2022:15385744221144142. [PMID: 36475999 DOI: 10.1177/15385744221144142] [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: 12/12/2022]
Abstract
Heavily calcified arterial lesions are difficult to treat in an endovascular manner with conventional techniques due to limited arterial compliance. Intravascular lithotripsy offers a novel minimally invasive therapeutic option through endovascular emission of acoustic waves, fracturing calcium deposits and facilitating lesion dilation. We present the case of a successful application of the Shockwave intravascular lithotripsy system (IVL®, Shockwave Medical Inc) in a heavily calcified stenosis of the right renal artery in a patient with a coral reef aorta.
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Affiliation(s)
- Yannick Vancampenhout
- Department of Vascular Surgery, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Laura Kerselaers
- Department of Vascular Surgery, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Dimitri Aerden
- Department of Vascular Surgery, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Sarah Gallala
- Department of Vascular Surgery, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Erik Debing
- Department of Vascular Surgery, 60201Universitair Ziekenhuis Brussel, Brussel, Belgium
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13
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Kalzifizierte Stenosen richtig behandeln. Herz 2022; 47:503-512. [DOI: 10.1007/s00059-022-05144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
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14
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Saito S, Yamazaki S, Takahashi A, Namiki A, Kawasaki T, Otsuji S, Nakamura S, Shibata Y. Intravascular Lithotripsy for Vessel Preparation in Calcified Coronary Arteries Prior to Stent Placement ― Japanese Disrupt CAD IV Study 1-Year Results ―. Circ Rep 2022; 4:399-404. [PMID: 36120480 PMCID: PMC9437473 DOI: 10.1253/circrep.cr-22-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
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Torp Kristensen A, Jakobsen JC, Olsen NT. Percutaneous coronary intervention in calcified stenoses: a protocol for a systematic review with meta-analysis, trial sequential analysis and network meta-analysis. BMJ Open 2022; 12:e063884. [PMID: 36691161 PMCID: PMC10439345 DOI: 10.1136/bmjopen-2022-063884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Severely calcified coronary stenoses are difficult to treat with percutaneous coronary interventions. The presence of severe calcifications complicates lesion preparation, advancement of stents and achievement of full stent expansion. Intervention in these lesions is associated with an increased risk of complications and procedural failure compared with treatment of less calcified lesions. Due to the high burden of comorbidity, patients with severely calcified lesions are often excluded from interventional trials, and there is little evidence on how to treat these patients. METHODS AND ANALYSIS We will conduct a systematic review of randomised trials enrolling patients with calcified coronary artery disease undergoing percutaneous coronary intervention. We will investigate any percutaneous treatment option including any lesion preparation, stenting or postdilatation technique. We will search The Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded, and Excerpta Medica database for studies from inception to 31 October 2022. The coprimary outcome is all-cause mortality and serious adverse events. If appropriate, we will conduct meta-analysis, trial sequential analysis and network meta-analysis. ETHICS AND DISSEMINATION No ethics approval is required for this study. The results will be published in a peer-reviewed journal in this field. PROSPERO REGISTRATION NUMBER CRD42021226034.
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Affiliation(s)
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Interventional Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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Edward K, Ela G. Endovascular treatment of calcific common femoral artery disease – The future or even present. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:85-86. [DOI: 10.1016/j.carrev.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
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17
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Rao RS, Sharma GN, Kunal S, Garhwal K, Bajiya S, Mehta P. Safety and procedural outcomes of intravascular lithotripsy in calcified coronaries in Indian patients. Indian Heart J 2022; 74:91-95. [PMID: 34998787 PMCID: PMC9039684 DOI: 10.1016/j.ihj.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Calcified coronaries still remain a major challenge for interventional cardiologist. This study aims to evaluate safety and efficacy of intravascular lithotripsy (IVL) in management of coronary artery calcification. Methods This was a retrospective single centre study regarding the utility of IVL in management of calcified coronaries. Patients with hemodynamically stable acute coronary syndrome or symptomatic chronic coronary syndrome (CCS) and calcified coronaries on angiography and who underwent IVL were enrolled. Intravascular imaging was performed wherever feasible. The primary endpoint was procedural success. In addition, data regarding procedural complications were collected. Results A total of 29 patients underwent IVL with a majority being males and having comorbidities such as hypertension and diabetes. A procedural success rate of 93.1% was achieved with no patient having >50% residual stenosis. IVL catheter was successfully delivered in all patients. The mean catheter diameter was 3.3 ± 0.4 mm and mean number of delivered pulses was 70.3 ± 16.4. The arteries most commonly intervened were the left main coronary and the left anterior descending artery. Intracoronary imaging revealed a significant increase in minimum luminal cross-sectional area (MLA) post IVL (pre-MLA: 5.1 ± 2.5 mm2; post-MLA: 10.7 ± 2.9 mm2; P<0.001). Two patients had in-hospital MACE in form of peri-procedural non Q-wave MI. No patient had arrhythmias, stent thrombosis, coronary perforation, or slow flow/no-reflow. Two patients had a rupture of IVL balloon while four had coronary artery dissection. Conclusions IVL is a safe and highly effective modality with high procedural success rate in management of calcified coronaries.
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Affiliation(s)
- Ravindra Singh Rao
- Department of Cardiology, RHL Heart Centre, Rajasthan Hospital, Jaipur, India
| | | | - Shekhar Kunal
- Department of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Kailash Garhwal
- Department of Cardiology, Maria Cecila Hospital, Cotignola, Italy
| | - Suresh Bajiya
- Department of Cardiology, RHL Heart Centre, Rajasthan Hospital, Jaipur, India
| | - Pawan Mehta
- Department of Cardiology, RHL Heart Centre, Rajasthan Hospital, Jaipur, India
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Intravascular Lithotripsy facilitated Percutaneous Coronary Intervention in patients with Calcific Disease: Shockwave makes a difference. Trends Cardiovasc Med 2022; 33:223-224. [PMID: 35066150 DOI: 10.1016/j.tcm.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
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19
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Mousa MA, Bingen BO, Amri IA, Digiacomo S, Karalis I, Jukema JW, Montero-Cabezas JM. Bail-out intravascular lithotripsy for the treatment of acutely underexpanded stents in heavily calcified coronary lesions: A case series. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40:189-194. [DOI: 10.1016/j.carrev.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
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20
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Kassimis G, Theodoropoulos KC, Didagelos M, Ziakas A. Successful off-label use of rotational atherectomy in ST-segment elevation myocardial infarction: A case report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:272-275. [PMID: 34801421 DOI: 10.1016/j.carrev.2021.11.014] [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: 09/25/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Rotational atherectomy (RA) in ST-segment elevation myocardial infarction (STEMI) is uncommon and its use in a thrombotic lesion is labelled a contraindication by its manufacturer due to the concern for further increase in platelet activation and aggregation by the spinning burr or distal embolization of the thrombotic material promoting no-reflow (NR). However, thrombus burden varies significantly in the STEMI setting and can be classified according to the thrombolysis in myocardial infarction (TIMI) thrombus grade (TG). This case demonstrates the successful off-label use of RA-assisted primary percutaneous coronary intervention to facilitate treatment of a heavily calcified ostial right coronary artery lesion with low thrombotic burden (TIMI TG 0) in an octogenarian STEMI patient. Atherectomy drug cocktails, intracoronary vasodilators, short burr runs and avoidance of rotating the burr at slower than minimum approved rotational speed contribute to atherectomy success and decrease the chances of NR.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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21
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Rheude T, Rai H, Richardt G, Allali A, Abdel-Wahab M, Sulimov DS, Mashayekhi K, Ayoub M, Cuculi F, Bossard M, Kufner S, Xhepa E, Kastrati A, Fusaro M, Joner M, Byrne RA, Cassese S. Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial. EUROINTERVENTION 2021; 17:481-488. [PMID: 33258774 PMCID: PMC9724952 DOI: 10.4244/eij-d-20-01000] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The comparative efficacy of balloon-based techniques to prepare severely calcified coronary lesions before stenting remains poorly studied. AIMS We sought to compare stent expansion following preparation of severely calcified coronary lesions with either a super high-pressure balloon or a scoring balloon. METHODS In this randomised, open-label trial, patients with severely calcified coronary lesions were enrolled at five centres in Germany and Switzerland. After unsuccessful lesion preparation with a standard non-compliant balloon (<30% reduction of baseline diameter stenosis), participants were randomised to predilation with either a super high-pressure balloon or a scoring balloon before drug-eluting stent (DES) implantation. The primary endpoint of the study was stent expansion index as assessed by optical coherence tomography (OCT). The key secondary endpoints included angiographic, strategy and procedural success. RESULTS OCT data after DES implantation were available for 70 out of 74 patients (94.6%) enrolled. Lesion preparation with a super high-pressure balloon versus a scoring balloon led to a comparable stent expansion index (0.72±0.12 vs 0.68±0.13; p=0.22). Compared with the scoring balloon, the super high-pressure balloon increased the minimum lumen diameter (2.83±0.34 mm vs 2.65±0.36 mm; p=0.03) and reduced the diameter stenosis (11.6±4.8% vs 14.4±5.6%; p=0.02) without difference in terms of angiographic success (100% vs 97.3%; p>0.99). Strategy success (91.9% vs 83.8%; p=0.48) and procedural success (100% vs 89.2%; p=0.12) were numerically more frequent with the super high-pressure balloon versus the scoring balloon. CONCLUSIONS In patients with severely calcified coronary artery lesions, preparation with a super high-pressure balloon versus a scoring balloon was associated with comparable stent expansion on intravascular imaging and a trend towards improved angiographic performance. Visual summary. A ComparIson of Strategies to PrepAre SeveRely CALCified Coronary Lesions: the ISAR-CALC randomised trial.
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Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Himanshu Rai
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Dmitriy S. Sulimov
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Florim Cuculi
- Department of Cardiology, Kantonspital Luzern, Lucerne, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Kantonspital Luzern, Lucerne, Switzerland
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert A. Byrne
- Cardiology Department, Mater Private Hospital, Dublin, Ireland,Cardiovascular Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
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22
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Liang B, Gu N. Evaluation of the Safety and Efficacy of Coronary Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Stenoses: Evidence From the Serial Disrupt CAD Trials. Front Cardiovasc Med 2021; 8:724481. [PMID: 34490380 PMCID: PMC8416910 DOI: 10.3389/fcvm.2021.724481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Previous understanding holds that rotational atherectomy and modified balloons remain the default strategy for severely calcified coronary stenoses. In recent years, coronary intravascular lithotripsy (IVL) provides new ideas. This study was conducted to evaluate the safety and efficacy of IVL for the treatment of severely calcified coronary stenoses. Methods: The serial Disrupt CAD trials (Disrupt CAD I, Disrupt CAD II, Disrupt CAD III, and Disrupt CAD IV) were included in this study. The safety endpoint was freedom from major adverse cardiovascular events (MACE) in hospital, at 30 days, and at 6 months following the index procedure. The efficacy endpoints included procedural success and angiographic success. Optical coherence tomography (OCT) was used to evaluate the mechanism of action of IVL quantifying the coronary artery calcification (CAC) characteristics and calcium plaque fracture. Results: We enrolled a total of 628 patients with a mean age of 71.8 years, 77.1% males. In these patients, the left anterior descending artery and right coronary artery were the most vulnerable vessels. The diameter stenosis was 64.6 ± 11.6% and the lesion length was 24.2 ± 11.4 mm. IVL had a favorable efficacy (93.0% procedural success, 97.5% angiographic success, and 100.0% stent delivery). Among the 628 patients, 568, 568, and 60 reported MACE endpoints in hospital, at 30 days, and at 6 months, respectively. The results showed that 528, 514, and 55 patients were free from MACE in hospital, at 30 days, and at 6 months, respectively. OCT measurements demonstrated that calcium fracture was the underlying mechanism of action for coronary IVL. Conclusions: IVL is safe and efficient for severely calcified coronary stenoses, and, importantly, calcium fracture facilitated increased vessel compliance and favorable stent expansion.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Patoulias D, Voultsos P, Papadopoulos C, Rocchiccioli P, Karamasis GV, Alexopoulos D, Sianos G. Shockwave coronary intravascular lithotripsy system for heavily calcified de novo lesions and the need for a cost-effectiveness analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:128-134. [PMID: 34246610 DOI: 10.1016/j.carrev.2021.06.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
The optimal management for severely calcified coronary artery disease is multi-adjunctive. Different strategies with dedicated devices should be available in the cardiac catheterization laboratory with their selection depending on the nature of the calcific disease and its anatomical distribution. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion preparation of heavily calcified plaques in coronary and peripheral vessels. S-IVL is based on the fundamental principles of lithotripsy, a technology that has been used to modify renal stones for over 30 years. Pulsatile mechanical energy is used to fragment selectively amorphous calcium, sparing soft tissue. S-IVL has the potential of more widespread adoption because of its proven safety, efficacy and operational simplicity, but cost-effectiveness of such advanced technology will need to be analyzed.
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Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece; 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece.
| | - Antonios Ziakas
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece; Interventional Cardiology Department, West of Scotland Heart and Lung Centre, Golden Jubilee National, Hospital, Clydebank, United Kingdom
| | | | - Dimitrios Patoulias
- 2nd Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Petros Voultsos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Christodoulos Papadopoulos
- 3rd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Paul Rocchiccioli
- Interventional Cardiology Department, West of Scotland Heart and Lung Centre, Golden Jubilee National, Hospital, Clydebank, United Kingdom
| | - Grigoris V Karamasis
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Alexopoulos
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Sianos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
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Tepe G, Brodmann M, Werner M, Bachinsky W, Holden A, Zeller T, Mangalmurti S, Nolte-Ernsting C, Bertolet B, Scheinert D, Gray WA. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv 2021; 14:1352-1361. [PMID: 34167675 DOI: 10.1016/j.jcin.2021.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/05/2021] [Accepted: 04/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The study sought to compare short-term outcomes in patients with femoropopliteal artery calcification receiving vessel preparation with intravascular lithotripsy (IVL) or percutaneous transluminal angioplasty (PTA) prior to drug-coated balloon (DCB) for symptomatic peripheral artery disease. BACKGROUND Endovascular treatment of calcified peripheral artery lesions is associated with suboptimal vessel expansion and increased complication risk. Although initial results from single-arm studies with IVL have been reported, comparative evidence from randomized trials is lacking for most devices in the presence of heavy calcification. METHODS The Disrupt PAD III (Shockwave Medical Peripheral Lithoplasty System Study for PAD) randomized trial enrolled patients with moderate or severe calcification in a femoropopliteal artery who underwent vessel preparation with IVL or PTA prior to DCB or stenting. The primary endpoint was core lab-adjudicated procedural success (residual stenosis ≤30% without flow-limiting dissection) prior to DCB or stenting. RESULTS In patients receiving IVL (n = 153) or PTA (n = 153), procedural success was greater in the IVL group (65.8% vs. 50.4%; p = 0.01) and the percentage of lesions with residual stenosis ≤30% (66.4% vs. 51.9%; p = 0.02) was greater in the IVL group, while flow-limiting dissections occurred more frequently in the PTA group (1.4% vs. 6.8%; p = 0.03). Post-dilatation (5.2% vs. 17.0%; p = 0.001) and stent placement (4.6% vs. 18.3%; p < 0.001) were also greater in the PTA group. The rates of major adverse events (IVL: 0% vs. PTA: 1.3%; p = 0.16) and clinically driven target lesion revascularization (IVL: 0.7% vs. PTA: 0.7%; p = 1.0) at 30 days were comparable between groups. CONCLUSIONS IVL is an effective vessel preparation strategy that facilitates definitive endovascular treatment in calcified femoropopliteal arteries in patients with peripheral artery disease. (Shockwave Medical Peripheral Lithoplasty System Study for PAD [Disrupt PAD III]; NCT02923193).
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Affiliation(s)
- Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Klinikum, Rosenheim, Germany
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Universitätsklinikum LKH Graz, Graz, Austria
| | - Martin Werner
- Department of Angiology, Hanusch Krankenhaus, Vienna, Austria
| | - William Bachinsky
- UPMC Heart and Vascular Institute, UPMC Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Thomas Zeller
- Division of Angiology, Department of Internal Medicine, Universitäts-Herzzentrum Freiburg and Bad Krozingen, Bad Krozingen, Germany
| | - Sarang Mangalmurti
- Department of Interventional Cardiology, Main Line Hospitals, Bryn Mawr, Pennsylvania, USA
| | - Claus Nolte-Ernsting
- Department of Radiology, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Barry Bertolet
- Cardiology Associates Research LLC, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Dierk Scheinert
- Department of Interventional Angiology, Universitätsklinikum Leipzig AoR, Leipzig, Germany
| | - William A Gray
- Division of Cardiology, Main Line Health, Wynnewood, Pennsylvania, USA.
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Diepenbruck S, Dalla-Pozza R, Pattathu J, Haas N, Jakob A. Successful intravascular pulmonary lithotripsy in a child with chronic thromboembolic pulmonary hypertension. Pediatr Pulmonol 2021; 56:1690-1693. [PMID: 33634582 DOI: 10.1002/ppul.25338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
Intravascular lithotripsy (IVL) is a novel method based on pulsatile ultrasonic pressure waves specifically aimed to modify circumferential and transmural calcium plaques. We report on the successful application of a shockwave IVL catheter® in a child with chronic thromboembolic pulmonary hypertension due to calcified thrombi in both lower lobes. Compared to conventional high-pressure balloon angioplasty, a significant perfusion-improvement was achieved with a shockwave IVL catheter® (4 mm) of the treated right pulmonary artery branch. Furthermore, subsequent surgical thrombectomy was reported to be considerably easier for the shockwave-treated thrombotic areas than the high-pressure balloon-only-treated thrombus. In conclusion, the shockwave IVL catheter® may be a promising option in chronic thromboembolic lesions in PA (pulmonary artery) position, and furthermore might be an option when treating children.
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Affiliation(s)
- Sabine Diepenbruck
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - André Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
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Kassimis G, Ziakas A, Didagelos M, Theodoropoulos KC, Hadjimiltiades S. How Should I Get Prepared for and Treat Rota Burr Entrapment in a Focally Underexpanded and Restenosed Stent: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:197-200. [PMID: 34031007 DOI: 10.1016/j.carrev.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Although high-speed rotational atherectomy has been successfully used in selected cases of stent underexpansion secondary to heavy peri-stent calcification, a higher risk of burr entrapment demands extreme caution and surgical back-up on site. The main cause of this complication is the lack of diamond dust on the back end of the burr, which prevents backward ablation of tissues when retracted. To date, only few reports of successful burr retrieval using percutaneous bailout techniques have been published. We report a case of burr entrapment within a previously implanted left circumflex artery stent which was successfully recaptured using the dual catheter technique; following the retrieval the patient underwent routine percutaneous coronary intervention.
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Affiliation(s)
- George Kassimis
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Antonios Ziakas
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Theodoropoulos
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Hadjimiltiades
- First Cardiology Department, University General Hospital AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece
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27
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Saito S, Yamazaki S, Takahashi A, Namiki A, Kawasaki T, Otsuji S, Nakamura S, Shibata Y. Intravascular Lithotripsy for Vessel Preparation in Severely Calcified Coronary Arteries Prior to Stent Placement ― Primary Outcomes From the Japanese Disrupt CAD IV Study ―. Circ J 2021; 85:826-833. [DOI: 10.1253/circj.cj-20-1174] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Shigeru Saito
- Department of Cardiology, Shonan-Kamakura General Hospital
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital
| | | | - Atsuo Namiki
- Department of Cardiology, JOHAS Kanto-Rosai Hospital
| | | | - Satoru Otsuji
- Department of Cardiology, Higashi-Takarazuka Satoh Hospital
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28
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Efficacy and safety of intravascular lithotripsy in calcified coronary lesions: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:73-82. [PMID: 34024748 DOI: 10.1016/j.carrev.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a recently introduced therapeutic modality in the management of calcified coronary lesions (CCAD). IVL delivers sonic pressure waves to modulate calcium, hence promote vessel compliance and optimize stent deployment. METHODS We performed a comprehensive literature search for studies that evaluated the utility of adjunctive IVL. The primary outcomes of our study were the clinical success, defined as the ability of IVL to produce residual diameter stenosis <50% (RDS < 50%) after stenting with no evidence of in-hospital major adverse cardiac events, and the angiographic success, defined as success in facilitating stent delivery with RDS < 50% and without serious angiographic complications. The secondary outcomes included post-IVL and post-stenting changes in lumen area, calcium angle, and the maximum calcium thickness. Proportional analysis was used for binary data and mean difference was used for continuous data. All meta-analyses were conducted using a random-effect model and 95% confidence intervals (CIs) were included. RESULTS A total of eight single-arm observational studies, including 980 patients (1011 lesions), were included. 48.8% of the patients presented with acute coronary syndrome. Severe calcifications were present in 97% of lesions. Clinical success was achieved in 95.4% of patients (95%CI:92.9%-97.9%). Angiographic success was achieved in 97% of patients (95%CI:95%-99%). There was an overall increase in postprocedural lumen area as well as significant reduction of calcium angle and maximum calcium thickness. CONCLUSIONS IVL seems to have excellent efficacy and safety in the management of CCAD. However, adequately powered RCTs are needed to evaluate IVL compared to other calcium/plaque modifying techniques.
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29
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Agrawal Y, Zoltowska D, Nazroo JYR, Halabi AR. Impella-Assisted Intracoronary Lithotripsy of Severely Calcified Left Main Coronary Artery Bifurcation for NSTEMI With Cardiogenic Shock. Cureus 2021; 13:e14772. [PMID: 34094737 PMCID: PMC8164825 DOI: 10.7759/cureus.14772] [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: 11/05/2022] Open
Abstract
High calcification of coronary artery plaque is a frequent cause of suboptimal stent expansion, which can result in stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL) represents a new frontier in the treatment of highly calcified coronary lesions. It can be an excellent alternative to intracoronary atherectomy in extremely high-risk lesions. We present a case of a 57-year-old man with known severe coronary artery disease (CAD) who presented with non-ST segment elevation myocardial infarction (NSTEMI), cardiogenic shock and was successfully treated with impella-assisted shockwave-intravascular lithotripsy permitting successful percutaneous intervention of a high-risk left main coronary artery (LMCA) bifurcation in-stent restenosis.
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Affiliation(s)
- Yashwant Agrawal
- Interventional Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, USA.,Interventional Cardiology, Ascension Health, Kalamazoo, USA
| | - Dominika Zoltowska
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - Abdul R Halabi
- Interventional Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, USA
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30
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Sogomonian R, Bernhardt L, Sood A, Bazi L, Kataria V, Gowda RM. Intravascular shockwave lithotripsy as a treatment modality for symptomatic mesenteric ischemia. Future Cardiol 2021; 17:1313-1320. [PMID: 33739167 DOI: 10.2217/fca-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic mesenteric ischemia has traditionally been treated with either open surgical revascularization or endovascular therapy. Endovascular surgery has typically been preferred due to the lower rates of peri-procedural and post-procedural morbidity, yet this comes at the expense of long-term durability. Intravascular shockwave lithotripsy is a technique utilized to modify intimal and medial calcified plaque in order to improve vessel expansion and patency. Intravascular lithotripsy has been investigated as both primary and adjunctive treatment for peripheral arterial and coronary arterial lesions, however, its use in the treatment of chronic mesenteric ischemia requires further investigation. We present a case of a 75-year-old woman with symptomatic mesenteric ischemia who underwent intravascular shockwave lithotripsy of a 99% stenosis superior mesenteric artery with an excellent outcome.
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Affiliation(s)
- Robert Sogomonian
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Logan Bernhardt
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai (Beth Israel), New York, NY 10003, USA
| | - Abhinav Sood
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Lucas Bazi
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Vikaas Kataria
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Ramesh M Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
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31
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Drury R, Natale C, Hellstrom WJG. Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction. Ther Adv Urol 2021; 13:17562872211002059. [PMID: 33796149 PMCID: PMC7968013 DOI: 10.1177/17562872211002059] [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: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is both a common and complex disease process. Existing ED treatments do not always achieve adequate results. There is clinical interest in employing regenerative therapies, including low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet rich plasma (PRP), and stem cell therapy (SCT), in the treatment of ED as adjunct or alternative treatments. Here, we present evidence for emerging shockwave- and cell-based regenerative therapies for the treatment of ED following a thorough review of the existing PubMed literature pertaining to Li-ESWT, PRP, and SCT in relation to the treatment of ED. Li-ESWT causes microtrauma in tissue that hypothetically upregulates angiogenesis and recruits stem cells. Several large-scale systematic reviews and meta-analyses have reported that Li-ESWT improved ED in humans. Additionally, evidence has commenced to show that Li-ESWT may be effective against two recognized and complex etiologies of ED: diabetic and neurogenic. PRP delivers an autologous sample rich in growth factors to damaged tissue. Animal model studies have demonstrated improved erectile function recovery as well as preservation of cavernous nerve axons. Studies with PRP in humans are limited. SCT utilizes the regenerative potential of stem cells for healing of damaged tissue. In the treatment of ED, SCT has been used in the setting of diabetic and post-prostatectomy ED. Results of human studies are varied, although SCT treatments did result in increased erectile rigidity with some patients recovering the ability to achieve penetration. While these regenerative therapies show potential to augment the current treatment regimen for ED, there is a paucity of evidence to support the safety and efficacy of these treatments. Further research is necessary to define the role of these alternative therapies in the treatment of ED.
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Affiliation(s)
- Robert Drury
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Caleb Natale
- Tulane University School of Medicine, New Orleans, LA, USA
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32
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Lee HY, Lim S, Park S. Role of Inflammation in Arterial Calcification. Korean Circ J 2021; 51:114-125. [PMID: 33525066 PMCID: PMC7853899 DOI: 10.4070/kcj.2020.0517] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 01/11/2023] Open
Abstract
Arterial calcification, characterized by calcium phosphate deposition in the arteries, can be divided into intimal calcification and medial calcification. The former is the predominant form of calcification in coronary artery plaques; the latter mostly affects peripheral arteries and aortas. Both forms of arterial calcification have strong correlations with adverse cardiovascular events. Intimal microcalcification is associated with increased risk of plaque disruption while the degree of burden of coronary calcification, measured by coronary calcium score, is a marker of overall plaque burden. Continuous research on vascular calcification has been performed during the past few decades, and several cellular and molecular mechanisms and therapeutic targets were identified. However, despite clinical trials to evaluate the efficacy of drug therapies to treat vascular calcification, none have been shown to have efficacy until the present. Therefore, more extensive research is necessary to develop appropriate therapeutic strategies based on a thorough understanding of vascular calcification. In this review, we mainly focus on intimal calcification, namely the pathobiology of arterial calcification, and its clinical implications.
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Affiliation(s)
- Hae Young Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Soyeon Lim
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.
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33
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Chiang CSM, Alan Chan KC, Lee M, Chan KT. Orbital-Tripsy: Novel Combination of Orbital-Atherectomy and Intravascular-Lithotripsy, in Calcified Coronaries After Failed Intravascular-Lithotripsy. JACC Case Rep 2020; 2:2437-2444. [PMID: 34317190 PMCID: PMC8305089 DOI: 10.1016/j.jaccas.2020.10.027] [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: 07/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022]
Abstract
Calcified coronary lesions are notorious for posing technical difficulty during angioplasty. Fortunately, more devices are available to tackle coronary calcifications. However, there remain difficult cases whereby a single modality is insufficient. Here we report the feasibility and success of a case, using Novo combination of Shockwave Lithotripsy after Orbital Atherectomy. (Level of Difficulty: Intermediate.).
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Key Words
- CABG, coronary artery bypass grafting
- IVL, intravascular lithotripsy
- LM, left main
- MLA, minimal luminal area
- OA, orbital atherectomy
- OCT, optical coherence tomography
- PCI, percutaneous coronary intervention
- RA, rotational atherectomy
- RCA, right coronary artery
- TVD, triple vessel disease
- coronary angiography
- coronary calcium score
- imaging
- myocardial ischemia
- percutaneous coronary intervention
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Affiliation(s)
| | - Ka Chun Alan Chan
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Michael Lee
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Kam Tim Chan
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
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34
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Kassimis G, Banning AP. Reply to the Letter to the Editor Entitled "Intravascular Lithotripsy Facilitated Cardiovascular Interventions". Angiology 2020; 72:98. [PMID: 33021101 DOI: 10.1177/0003319720963603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, 69200Aristotle University of Thessaloniki, Hippokration Hospital, Greece.,1st Cardiology Department, AHEPA General Hospital, 69200Aristotle University of Thessaloniki, Greece
| | - Adrian P Banning
- Oxford Heart Centre, 11269John Radcliffe Hospital, Oxford, United Kingdom
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35
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Butt N, Arshid A, Javed H, Kayani WT, Ahmad SA, Khalid N. Intravascular Lithotripsy Facilitated Cardiovascular Interventions. Angiology 2020; 72:97. [PMID: 32911953 DOI: 10.1177/0003319720956484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nausharwan Butt
- Section of Internal Medicine, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Awais Arshid
- 473270Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - Hasan Javed
- Section of Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Waleed Tallat Kayani
- Section of Interventional Cardiology, 3989Baylor College of Medicine, Houston, TX, USA
| | - Sarah Aftab Ahmad
- Section of Cardiothoracic Surgery, St. Francis Medical Center, Monroe, LA, USA
| | - Nauman Khalid
- Section of Interventional Cardiology, St. Francis Medical Center, Monroe, LA, USA
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