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Visinoni ZM, Jurewitz DL, Kereiakes DJ, Shlofmitz R, Shlofmitz E, Ali Z, Hill J, Lee MS. Coronary intravascular lithotripsy for severe coronary artery calcification: The Disrupt CAD I-IV trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:81-87. [PMID: 38472025 DOI: 10.1016/j.carrev.2024.03.001] [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: 11/27/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Coronary artery calcification (CAC) severity is associated with increased vessel inflammation, atherosclerosis, stent failure, and risk of percutaneous coronary intervention-related complications. Current modalities for CAC modification include atherectomy techniques (rotational, orbital, and laser) and balloon modification (cutting and scoring). However, these methods are limited by their risk of slow flow/no reflow, coronary dissection, perforation, and myocardial infarction. Intravascular lithotripsy (IVL) emits high-energy sonic waves that induce calcium fractures within a target lesion to improve vessel compliance for stent placement. Low rates of major cardiac adverse events (MACE) and high rates of procedural and angiographic success were observed with IVL in the Disrupt CAD I-IV trials. Optical coherence tomography sub-studies identified calcium fracture as the likely etiology of improved vessel compliance and increased luminal diameter post-IVL. Rates of MACE, procedural, and angiographic success were consistent across the Disrupt CAD trials, suggesting IVL is less operator-dependent compared to other calcium-modifying techniques. Coronary IVL offers interventional cardiologists a safe and effective method of severe CAC modification, while providing reproducible outcomes.
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Affiliation(s)
- Zachary M Visinoni
- Sutter Roseville Medical Center, Roseville, CA, United States of America
| | - Daniel L Jurewitz
- Sutter Roseville Medical Center, Roseville, CA, United States of America
| | - Dean J Kereiakes
- The Carl and Edyth Lindner Research Center at The Christ Hospital, Cincinnati, OH, United States of America
| | - Richard Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Evan Shlofmitz
- St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, United States of America
| | - Jonathan Hill
- Royal Bromptom Hospital, London, England, United Kingdom of Great Britain and Northern Ireland
| | - Michael S Lee
- Innovative Medical Solutions, Beverly Hills, CA, United States of America.
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2
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Leick J, Rheude T, Denne M, Tobias K, Cassese S, Kastrati A, Afzal S, Hug KP, Saad L, Lauterbach M, Werner N. Comparison of long-term outcome in patients with in-stent restenosis treated with intravascular lithotripsy or with modified balloon angioplasty. Clin Res Cardiol 2024; 113:1030-1040. [PMID: 38112745 DOI: 10.1007/s00392-023-02357-3] [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: 06/22/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Modified balloon angioplasty (MB) using a cutting-/scoring balloon or intravascular lithotripsy (IVL) is used in patients with in-stent restenosis (ISR). However, IVL is an off-label use in this setting. The aim of this subgroup analysis of an all-comers registry was to compare IVL to MB angioplasty in patients with ISR. METHODS The subgroup (n = 117) included all patients with an ISR treated by MB or IVL between 2019 and 2021. Primary endpoint was strategy success (< 20% residual stenosis). The secondary endpoint was cardiac death, acute myocardial infarction (AMI) and target lesion failure/revascularization (TVR). Quantitative coronary angiography was performed in all patients. RESULTS A total of n = 36 patients were treated by IVL and n = 81 patients by MB. No significant differences in baseline characteristics were observed between the groups. The primary endpoint was reached in 99 patients (84.6%). Patients in the IVL group had less residual stenosis (2.8% vs. 21.0%; p = 0.012). Multivariate regression analysis revealed that IVL had a significant positive effect on reaching the primary end point (Estimate 2.857; standard error (SE) 1.166; p = 0.014). During the follow-up period (450 days) there were no significant differences in rates of cardiac death (IVL n = 2 (1.7%) vs. MB n = 3 (2.6%); p = 0.643), AMI (IVL n = 2 (1.7%) vs. MB n = 4 (3.4%); p = 0.999) and TVR (IVL n = 5 (4.3%) vs. MB n = 14 (12%); p = 0.851). CONCLUSION IVL results in a significantly lower rate of residual stenosis than MB in patients with ISR. During the long-term follow-up, no differences in rates of cardiac death, AMI or TVR were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany.
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Krause Tobias
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Shazia Afzal
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Karsten P Hug
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Louai Saad
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
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Kereiakes DJ. Editorial: Intravascular lithotripsy for post-implant stent under-expansion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:24-25. [PMID: 37949718 DOI: 10.1016/j.carrev.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA; The Christ Hospital Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA.
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van Oort MJH, Al Amri I, Bingen BO, Cordoba-Soriano JG, Karalis I, Sanz-Sanchez J, Oliveri F, van der Kley F, Jukema JW, Jurado-Roman A, Montero-Cabezas JM. Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:16-23. [PMID: 37923647 DOI: 10.1016/j.carrev.2023.10.013] [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: 08/29/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p < 0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2;p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2;p = 0.064) in late- and immediate-IVL were comparable. CONCLUSIONS IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.
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Affiliation(s)
- Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Juan G Cordoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ioannis Karalis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece.
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Dawood M, Elwany M, Abdelgawad H, Sanhoury M, Zaki M, Elsharkawy E, Nawar M. Coronary calcifications, the Achilles heel in coronary interventions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:1-17. [PMID: 38616941 PMCID: PMC11008515 DOI: 10.5114/aic.2024.136415] [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: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 04/16/2024] Open
Abstract
Percutaneous coronary intervention in severely calcified coronaries has been associated with higher rates of procedural complications, including myocardial infarction and death in addition to increased frequency of coronary revascularization on an intermediate and long-term basis. The SYNTAX score, which is designed to assess the complexity of coronary artery disease and aids in choosing a revascularization method, allocates two points per lesion when there is heavy calcification present on fluoroscopy. With the advent of novel multimodality imaging technologies, the detection and evaluation of coronary calcifications improved significantly over the last decade. Several tools are now available for modifying calcified lesions including different types of dedicated balloons and atherectomy devices, which may create some degree of confusion regarding the suitable application of each instrument. The aim of this review is to cover this vital topic from different aspects. First, we tried to provide an overview on the pathophysiology and types of coronary calcification and its risk factors. Then, we outlined the available imaging modalities for the evaluation of calcified coronary lesions, highlighting the points of strength and weakness of each of them. A comprehensive discussion of calcium-modifying techniques was elaborated, summarizing their mechanism of action, pros and cons, and possible complications. Finally, an integrated algorithm was proposed for the best management of calcified coronary lesions.
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Affiliation(s)
- Moustafa Dawood
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moustafa Elwany
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hoda Abdelgawad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- King’s College Hospital NHS Trust, London, UK
| | | | - Moataz Zaki
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eman Elsharkawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Moustafa Nawar
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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6
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Lis P, Rajzer M, Klima Ł. The Significance of Coronary Artery Calcification for Percutaneous Coronary Interventions. Healthcare (Basel) 2024; 12:520. [PMID: 38470631 PMCID: PMC10931248 DOI: 10.3390/healthcare12050520] [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: 01/09/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of calcium deposits in coronary arteries grows with age. Risk factors include, e.g., diabetes and chronic kidney disease. There are several underlying pathophysiological mechanisms of calcium deposition. Severe calcification increases the complexity of percutaneous coronary interventions. Invasive techniques to modify the calcified atherosclerotic plaque before stenting have been developed over the last years. They include balloon- and non-balloon-based techniques. Rotational atherectomy has been the most common technique to treat calcified lesions but new techniques are emerging (orbital atherectomy, intravascular lithotripsy, laser atherectomy). The use of intravascular imaging (intravascular ultrasound and optical coherence tomography) is especially important during the procedures in order to choose the optimal strategy and to assess the final effect of the procedure. This review provides an overview of the role of coronary calcification for percutaneous coronary interventions.
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Affiliation(s)
| | | | - Łukasz Klima
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.L.); (M.R.)
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7
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Gruslova AB, Inanc IH, Cilingiroglu M, Katta N, Milner TE, Feldman MD. Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications. Catheter Cardiovasc Interv 2024; 103:295-307. [PMID: 38091341 DOI: 10.1002/ccd.30933] [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: 05/24/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024]
Abstract
Management of intracoronary calcium (ICC) continues to be a challenge for interventional cardiologists. There have been significant advances in calcium treatment devices. However, there still exists a knowledge gap regarding which devices to choose for the treatment of ICC. The purpose of this manuscript is to review the principles of intravascular lithotripsy (IVL) and clinical data. The technique of IVL will then be compared to alternative calcium treatment devices. Clinical data will be reviewed concerning the treatment of coronary, peripheral artery and valvular calcifications. Controversies to be discussed include how to incorporate IVL into your practice, what is the best approach for treating calcium subtypes, how to approach under-expanded stents, what is the ideal technique for performing IVL, how safe is IVL, whether imaging adds value when performing IVL, and how IVL fits into a treatment program for peripheral arteries and calcified valves.
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Affiliation(s)
- Aleksandra B Gruslova
- Division of Cardiology, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Ibrahim H Inanc
- Department of Cardiology, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey
| | - Mehmet Cilingiroglu
- Division of Cardiology, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
- MD Anderson Cancer Center, University of Texas in Houston, Houston, Texas, USA
| | - Nitesh Katta
- Beckman Laser Institute and Medical Clinic, University of California at Irvine, Irvine, California, USA
| | - Thomas E Milner
- Beckman Laser Institute and Medical Clinic, University of California at Irvine, Irvine, California, USA
| | - Marc D Feldman
- Division of Cardiology, Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
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Kuzemczak M, Lipiecki J, Jeyalan V, Farhat H, Kleczyński P, Legutko J, Minten L, Bennett J, Poels E, Dens J, Spyridopoulos I, Kunadian V, Pawłowski T, Gil R, Egred M, Zaman A, Alkhalil M. Clinical outcomes of coronary intravascular lithotripsy in patients with stent failure (COIL registry). Int J Cardiol 2023; 391:131274. [PMID: 37598907 DOI: 10.1016/j.ijcard.2023.131274] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) has been demonstrated to be an effective treatment of calcified de novo coronary lesions. Safety data on the use of IVL within stented segments are lacking. We sought to evaluate the safety, feasibility, and long-term outcomes of IVL in patients with stent failure. METHODS This was a retrospective multi-centre registry that included consecutive patients with stent failure who had undergone IVL treatment. The primary efficacy endpoint was procedural success defined as residual stenosis <30% (determined by quantitative coronary angiography analysis) in patients who survived hospital admission without in-hospital adverse events. Major adverse cardiovascular events (MACE) were defined as the composite endpoints of cardiovascular death, spontaneous myocardial infarction, and target vessel revascularisation at one-year follow up. RESULTS 102 patients were included in this study. Mean age was 73 ± 9 years and 81% were male. The duration from previous stent implantation and IVL treatment was 24 (interquartile range 7-76) months, of which 10.8% received IVL for acute under-expanded stent. IVL treatment allowed significant improvement in both minimal lumen diameter (1.14 ± 0.60 to 2.53 ± 0.59, P < 0.001) and degree of stenosis (66.8 ± 19.9 to 20.3 ± 11.3%, P < 0.001). The rate of procedural success was 78.4% (80/102 of patients). The one-year MACE was 15.7%. Ostial disease (HR 5.16; 95% CI 1.19 to 22.33; P = 0.028) and lesion length (HR 1.05; 95% CI 1.01 to 1.10; P = 0.010) were independently associated with one-year MACE. CONCLUSIONS In patients with stent failure, IVL is a safe and feasible treatment for this high-risk group.
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Affiliation(s)
- Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Poznań University of Medical Sciences, Division of Emergency Medicine, Poznań, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Visvesh Jeyalan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Lennert Minten
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Ioakim Spyridopoulos
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Robert Gil
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mohaned Egred
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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9
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Mohandes M, Pernigotti A, Moreno C, Torres LM, Fernández F, Zambrano D, Bardají A. Coronary laser with simultaneous contrast injection for the treatment of stent underexpansion. Cardiol J 2023; 31:235-242. [PMID: 37853825 DOI: 10.5603/cj.96438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Stent underexpansion is a challenge in interventional cardiology. Some off-label treatments, such as rotational atherectomy, intravascular lithotripsy (IVL) and coronary lasing, have been used to overcome the problem. The purpose of this study is to evaluate the safety and efficacy of coronary laser atherectomy with simultaneous contrast injection and subsequent balloon dilation to optimize stent expansion. METHODS Coronary laser atherectomy with simultaneous contrast injection was used. After lasing, non-compliant balloon dilation at high pressure was performed to overcome the underexpanded point. The average increase in the minimum stent area (MSA) was measured by intravascular ultrasound (IVUS), and any complication related to the technique was evaluated. Additionally, major adverse cardiovascular events (MACE), consisting of death from any cause, new myocardial infarction (MI) and target lesion revascularization (TLR), were scrutinized in a long-term follow-up. RESULTS Sixteen underexpanded stents were treated with laser between August 2017 and November 2022. In all cases but one, IVUS was used to evaluate the MSA before and after lasing. The MSA showed an average increase of 2.34 ± 1.57 mm² (95% confidence interval [CI]: 1.47-3.21; p < 0.001) after laser application and balloon inflation. No complication related to the technique was detected. During a follow-up period of a median (interquartile range) of 457 (50-973) days, the combined MACE assessed by Kaplan-Meier estimator showed an event-free rate of 0.82 (95% CI: 0.59-1). CONCLUSIONS Coronary laser with simultaneous contrast injection is a safe method to optimize a stent underexpansion, with an acceptable event-free rate in long-term follow-up.
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Affiliation(s)
- Mohsen Mohandes
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain.
| | - Alberto Pernigotti
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain
| | - Cristina Moreno
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain
| | - Luis Mauricio Torres
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain
| | - Francisco Fernández
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain
| | - Diego Zambrano
- Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Dr. Mallafré Guasch, Tarragona, Spain
| | - Alfredo Bardají
- Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV); Dr. Mallafré Guasch, Tarragona, Spain
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Farhat H, Kuzemczak M, Durel N, Caillot N, Pawłowski T, Lipiecki J. Rotational Atherectomy Versus Intravascular Lithotripsy for Calcified In-Stent Restenosis: A Single-Center Study With 1-Year Follow-Up. Am J Cardiol 2023; 205:413-419. [PMID: 37659262 DOI: 10.1016/j.amjcard.2023.07.174] [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: 03/21/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 09/04/2023]
Abstract
Although rotational atherectomy (RA) and intravascular lithotripsy (IVL) have been proved to be effective for calcified de novo coronary lesions, their use in patients with in-stent restenosis (ISR) is still controversial. No comparison of these techniques in patients with ISR has been published so far. We sought to evaluate safety and feasibility of RA and IVL in patients with calcified ISR. Furthermore, we aimed to compare in-hospital and 1-year clinical outcomes between both groups. This is a retrospective single-center study evaluating patients with calcified ISR treated with RA (between 2012 and 2021) and IVL (between 2019 and 2021). Inhospital and 1-year clinical outcomes were compared between IVL and RA patients. In total, 28 patients with ISR who underwent RA were compared with 24 ISR subjects after IVL. The procedural success rate was 100% in both the groups. Quantitative coronary analysis demonstrated a similar degree of stenosis prior (66.4 ± 11.4 vs 68.8 ± 19.7, p = nonsignificant [NS]), and after the procedure (21.5 ± 20.5 vs 22.8 ± 12.1, p = NS) with no difference in acute luminal gain (1.34 ± 0.60 vs 1.38 ± 0.59, p = NS). There was one in-hospital major adverse cardiovascular event in the RA group. At 1-year follow-up, no difference was observed with respect to major adverse cardiovascular event rate (14.3% vs 16.7%, p = NS) and target vessel revascularization (7.1% vs 12.5%, p = NS). In conclusion, RA and IVL are safe and feasible techniques for calcified ISR yielding comparable results at 1-year follow-up. Further clinical studies are warranted to confirm our findings and shed more light on patient and lesion characteristics associated with the best outcomes.
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Affiliation(s)
- Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Department of Emergency Medicine, Poznan University of Medical Sciences, Poznań, Poland.
| | - Nicolas Durel
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Nicolas Caillot
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
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11
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Caminiti R, Vetta G, Parlavecchio A, Ielasi A, Magnocavallo M, Della Rocca DG, Cerrato E, Carerj S, Di Bella G, Micari A, Vizzari G. A Systematic Review and Meta-Analysis Including 354 Patients from 13 Studies of Intravascular Lithotripsy for the Treatment of Underexpanded Coronary Stents. Am J Cardiol 2023; 205:223-230. [PMID: 37611414 DOI: 10.1016/j.amjcard.2023.07.144] [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: 01/20/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Abstract
Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologists. Stent underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis. To date, SU with heavily CCP can be addressed using very high-/high-pressure noncompliant balloons, off-label rotational atherectomy/orbital atherectomy, excimer laser atherectomy, and intravascular lithotripsy (IVL). In this meta-analysis, we investigated the success rate of IVL for the treatment of SU because of CCP. Studies and case-based experiences reporting on the use of IVL strategy for treatment of SU were included. The primary end point was IVL strategy success, defined as the adequate expansion of the underexpanded stent. A metanalysis was performed for the main focuses to calculate the proportions of procedural success rates with corresponding 95% confidence intervals (CIs). Random-effects models weighted by inverse variance were used because of clinical heterogeneity. This meta-analysis included 13 studies with 354 patients. The mean age was 71.3 years (95% CI 64.9 to 73.1), and 77% (95% CI 71.2% to 82.4%) were male. The mean follow-up time was 2.6 months (95% CI 1 to 15.3). Strategy success was seen in 88.7% (95% CI 82.3 to 95.1) of patients. The mean minimal stent area was reported in 6 studies, the pre-IVL value was 3.4 mm2 (95% CI 3 to 3.8), and the post-IVL value was 6.9 mm2 (95% CI 6.5 to 7.4). The mean diameter stenosis (percentage) was reported in 7 studies, the pre-IVL value was 69.4% (95% CI 60.7 to 78.2), and the post-IVL value was 14.6% (95% CI 11.1 to 18). The rate of intraprocedural complications was 1.6% (95% CI 0.3 to 2.9). In conclusion, the "stent-through" IVL plaque modification technique is a safe tool to treat SU caused by CCP, with a high success rate and a very low incidence of complications.
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Affiliation(s)
- Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfonso Ielasi
- Cardiology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital of Orbassano and Rivoli Infermi Hospital of Rivoli, Turin, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giampiero Vizzari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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12
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Ponna PK, Gonuguntla A, Botta RK, Kotaru S, Fischell TA, Kassier AA, Agrawal Y. Shock and Awe: Successful Revascularization with Intravascular Lithotripsy in Recurrent ST-Elevation Myocardial Infarction Secondary to Stent Under-Expansion. Methodist Debakey Cardiovasc J 2023; 19:55-60. [PMID: 37600449 PMCID: PMC10437133 DOI: 10.14797/mdcvj.1257] [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: 05/04/2023] [Accepted: 06/21/2023] [Indexed: 08/22/2023] Open
Abstract
We report a case of recurrent ST-segment elevation myocardial infarction (STEMI) due to a previously implanted under-expanded stent with in-stent thrombosis refractory to traditional interventional techniques. We underscore the utility of bail-out shockwave intravascular lithotripsy to tackle previously under-expanded stents in this acute setting.
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Affiliation(s)
- Pramod Kumar Ponna
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, US
| | | | | | - Sruthi Kotaru
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, US
| | - Tim A. Fischell
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, US
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13
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Sasi V, Szántó G, Achim A, Ungi I, Varga A, Ruzsa Z. Combination of Laser Atherectomy and Super High-pressure Non-compliant Balloon to Treat Stent Under-expansion in Cases of Failed Interventional Options. Interv Cardiol 2023; 18:e23. [PMID: 37538386 PMCID: PMC10394584 DOI: 10.15420/icr.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/23/2023] [Indexed: 08/05/2023] Open
Abstract
Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain. The authors report on a patient with prior numerous right coronary unsuccessful coronary interventions resulting in partially crushed multiple layers of stent material with critical lumen narrowing caused by stent under-expansion. Balloon angioplasty and stent rotational atherectomy (ROTA) had been attempted to overcome stent under-expansion but were unsuccessful. The authors investigated a new combination therapy of laser atherectomy (ELCA) and super high-pressure balloon (OPN non-compliant balloon) to treat single or multiple layers of stent with severe under-expansion due to fibrotic, calcified tissue surrounding the under-expanded stent structure.
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Affiliation(s)
- Viktor Sasi
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Gyula Szántó
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Alexandru Achim
- Department of Interventional Cardiology, Medicala 1 Clinic, Iuliu Hațieganu University of Medicine and PharmacyCluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital BasellandLiestal, Switzerland
| | - Imre Ungi
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Albert Varga
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
| | - Zoltán Ruzsa
- Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of SzegedSzeged, Hungary
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14
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Petousis S, Skalidis E, Zacharis E, Kochiadakis G, Hamilos M. The Role of Intracoronary Imaging for the Management of Calcified Lesions. J Clin Med 2023; 12:4622. [PMID: 37510737 PMCID: PMC10380390 DOI: 10.3390/jcm12144622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Interventional cardiologists in everyday practice are often confronted with calcified coronary lesions indicated for percutaneous transluminal coronary angioplasty (PTCA). PTCA of calcified lesions is associated with diverse technical challenges resulting in suboptimal coronary stenting and adverse long-term clinical outcomes. Angiography itself offers limited information regarding coronary calcification, and the adjuvant use of intracoronary imaging such as intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) can guide the treatment of calcified coronary lesions, optimizing the different stages of the procedure. This review offers a description of why, when, and how to use intracoronary imaging for PTCA of calcified coronary lesions in order to obtain the most favorable results. We used the PubMed and Google Scholar databases to search for relevant articles. Keywords were calcified coronary lesions, intracoronary imaging, IVUS, OCT, coronary calcium modification techniques, PTCA, and artificial intelligence in intracoronary imaging. A total of 192 articles were identified. Ninety-one were excluded because of repetitive or non-important information.
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Affiliation(s)
- Stylianos Petousis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Emmanouil Skalidis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Evangelos Zacharis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - George Kochiadakis
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
| | - Michalis Hamilos
- Cardiology Department, University Hospital of Heraklion, Voutes and Stavrakia, 71110 Heraklion, Crete, Greece
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15
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Duband B, Souteyrand G, Clerc JM, Chassaing S, Fichaux O, Marcollet P, Deballon R, Roussel L, Pereira B, Collet JP, Commeau P, Cayla G, Koning R, Motreff P, Benamer H, Rangé G. Prevalence, Management and Outcomes of Percutaneous Coronary Intervention for Coronary In-Stent Restenosis: Insights From the France PCI Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:39-46. [PMID: 36813696 DOI: 10.1016/j.carrev.2023.02.006] [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: 01/08/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Despite the evolution of stent technology, there is a non-negligible risk of in-stent restenosis (ISR) after Percutaneous coronary intervention (PCI). Large-scale registry data on the prevalence and clinical management of ISR is lacking. METHODS The aim was to describe the epidemiology and management of patients with ≥1 ISR lesions treated with PCI (ISR PCI). Data on characteristics, management and clinical outcomes were analyzed for patients undergoing ISR PCI in the France-PCI all-comers registry. RESULTS Between January 2014 and December 2018, 31,892 lesions were treated in 22,592 patients, 7.3 % of whom underwent ISR PCI. Patients undergoing ISR PCI were older (68.5 vs 67.8; p < 0.001), and more likely to have diabetes (32.7 % vs 25.4 %, p < 0.001), chronic coronary syndrome or multivessel disease. ISR PCI concerned drug eluting stents (DES) ISR in 48.8 % of cases. Patients with ISR lesions were more frequently treated with DES than drug eluting balloon or balloon angioplasty (74.2 %, 11.6 % and 12.9 %, respectively). Intravascular imaging was rarely used. At 1 year, patients with ISR had higher target lesion revascularization rates (4.3 % vs. 1.6 %; HR 2.24 [1.64-3.06]; p < 0.001). CONCLUSIONS In a large all-comers registry, ISR PCI was not infrequent and associated with worse prognosis than non-ISR PCI. Further studies and technical improvements are warranted to improve the outcomes of ISR PCI.
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Affiliation(s)
- Benjamin Duband
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Géraud Souteyrand
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Olivier Fichaux
- Cardiology Department, Centre Hospitalo-Régional d'Orléans, Orléans, France
| | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier Jacques Cœur, Bourges, France
| | | | - Laurent Roussel
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Philippe Commeau
- Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, Ollioules, France
| | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, Rouen, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Soissons, France
| | - Gregoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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16
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Montero-Cabezas JM, Al Amri I, van Oort MJH, Bingen BO, Scherptong RWC, van der Kley F. Retrograde Use of Intravascular Lithotripsy in Anterograde Uncrossable In-Stent Chronic Occlusion: "Retrotripsy Technique". JACC Cardiovasc Interv 2023:S1936-8798(23)00857-9. [PMID: 37354167 DOI: 10.1016/j.jcin.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023]
Affiliation(s)
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martijn J H van Oort
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brian O Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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17
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Leick J, Rheude T, Denne M, Cassese S, Kastrati A, Hauptmann F, Gehrig T, Kuna C, Lindner M, Lauterbach M, Werner N. Comparison of long-term outcome in patients with calcified stenosis treated with intravascular lithotripsy or with modified balloon angioplasty: a propensity score-adjusted study. Front Cardiovasc Med 2023; 10:1185422. [PMID: 37255702 PMCID: PMC10225498 DOI: 10.3389/fcvm.2023.1185422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Background The aim of this two-center, all-comers registry was to compare the effectiveness and safety of intravascular lithotripsy (IVL) to that of modified balloon angioplasty (MB). MB angioplasty using a cutting or scoring balloon is commonly used in patients with calcified coronary arteries. IVL is a new technology for lesion preparation. This is the first study to compare MB with IVL. Methods The cohort included all patients treated by MB angioplasty or IVL between 2019 and 2021. The primary endpoint was strategy success (<20% residual stenosis). The secondary endpoint was long-term safety outcomes [cardiac death, acute myocardial infarction (AMI), target lesion failure/revascularization (TVR)]. Quantitative coronary angiography (QCA) was performed in all patients. Primary and secondary endpoints were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. Results A total of n = 86 patients were treated by IVL and n = 92 patients by MB angioplasty. The primary endpoint was reached in 152 patients (85.4%). Patients in the IVL group had less residual stenosis (5.8% vs. 22.8%; p = 0.001) in QCA. Weighted multivariable regression analysis revealed that IVL had a significant positive effect on reaching the primary endpoint of strategy success [odds ratio (OR) 24.58; 95% confidence interval (95% CI) 7.40-101.86; p = 0.001]. In addition, severe calcification was shown to result in a lower probability of achieving the primary endpoint (OR 0.08; 95% CI 0.02-0.24; p = 0.001). During the follow-up period (450 days) there was no difference in cardiovascular mortality rate [IVL (n = 5) 2.8% vs. MB (n = 3) 1.7%; p = 0.129]. Patients with unstable angina at the time of the index procedure had the highest probability of cardiovascular death [hazard ratio (HR) 7.136; 95% CI 1.248-40.802; p = 0.027]. No differences were found in long-term rates of AMI (IVL 1.7% vs. MB 2.8%; p = 0.399; IVL HR 2.73; 95% CI 0.4-17.0; p = 0.281) or TVR (IVL 5.6% vs. MB 9%; p = 0.186; IVL HR 0.78; 95% CI 0.277-2.166; p = 0.626). Conclusion IVL leads to a significantly better angiographic intervention outcome compared to MB angioplasty in our cohort. During long-term follow-up, no differences in cardiovascular mortality, rate of acute myocardial infarction, or target lesion failure/revascularization were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Felix Hauptmann
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Thomas Gehrig
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Constantin Kuna
- Department of Cardiovascular Diseases, German Heart Centre, Technical University Munich, Munich, Germany
| | - Michael Lindner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Trier, Germany
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18
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Sardella G, Stefanini G, Leone PP, Boccuzzi G, Fovero NT, Van Mieghem N, Giacchi G, Escaned J, Fineschi M, Testa L, Valenti R, Di Mario C, Briguori C, Cortese B, Ribichini F, Oreglia JA, Colombo A, Sangiorgi G, Barbato E, Sonck J, Ugo F, Trani C, Castriota F, Paggi A, Porto I, Tomai F, Mancone M. Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry. Am J Cardiol 2023; 198:1-8. [PMID: 37182254 DOI: 10.1016/j.amjcard.2023.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis <30% by quantitative coronary angiography. Primary safety end point was freedom from serious angiographic complications, which included >National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow <3, and acute thrombosis. A total of 160 patients were enrolled between June 2020 and June 2022. The primary efficacy end point was observed in 155 patients (96.9%). The primary safety end point occurred in 145 cases (90.6%). Dissections >National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow <3 in 3 (1.9%), and perforation in 4 patients (2.5%). Free from inhospital major adverse cardiac and cerebrovascular events, including cardiac death, target vessel myocardial infarction, target lesion revascularization, cerebrovascular accident, definite/probable stent thrombosis, and major bleeding, occurred in 158 patients (98.7%). In conclusion, IVL after RA in lesions with severe CAC was effective and safe, with a very low incidence of complications as either elective or bail-out strategy.
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Affiliation(s)
- Gennaro Sardella
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Giacomo Boccuzzi
- Division of Cardiology, Department of Medicine, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Natalia Tovar Fovero
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | | | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IdISSC, Universidad Complutense de Madrid, C/ Profesor Martín Lagos, Madrid, Spain
| | - Massimo Fineschi
- Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Carlo Briguori
- Division of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Bernardo Cortese
- Foundation for Cardiovascular Research and Innovation, Milan, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jacopo Andrea Oreglia
- Department of Cardiology and de Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
| | | | - Emanuele Barbato
- Cardiology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Anita Paggi
- Laboratory of Interventional Cardiology; Department of Cardiology, S. Anna Hospital, Catanzaro, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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19
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Thandra A, Betts L, Aggarwal G, Gujjula N, Haddad TM. Intravascular Lithotripsy for Acute Stent Under-Expansion and In-Stent Restenosis: A Case Series. Curr Probl Cardiol 2023; 48:101511. [PMID: 36402215 DOI: 10.1016/j.cpcardiol.2022.101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Coronary in-stent restenosis (ISR) has an incidence of about 10% of percutaneous coronary interventions (PCIs) performed in the United States. Traditional management strategies for ISR include balloon angioplasty with non-compliant or use of cutting/scoring balloons or atheroablative therapies (like laser and rotational atherectomy), all of which are inherently limited in their ability to treat stent under-expansion or calcification around the stent. Shockwave intravascular lithotripsy (IVL) has recently demonstrated safe and efficacious treatment of severely calcified coronary stenoses with reported cases of treating ISR as an off-label use. In this case series, we describe the successful use of IVL for 6 cases of ISR and 1 case of stent under-expansion using 40-80 IVL pulses per lesion. Angiographic success was obtained in all seven patients, and there were no intra-procedural complications or adverse cardiac events at a mean follow-up of 200 days. Our report indicates that IVL can be safely and effectively used to treat ISR and stent under-expansion.
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Affiliation(s)
- Abhishek Thandra
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE.
| | - Lucas Betts
- Creighton University School of Medicine, Omaha, NE
| | - Gaurav Aggarwal
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Nagarjuna Gujjula
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Toufik M Haddad
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
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Hinton J, Mariathas M, Chan E, Patel A, Singh S, Konstantinou K, Din J, Kodoth V, Levy T, Swallow R, Talwar S, O'Kane P. Novel application of intravascular lithotripsy in stent under-expansion: A single-center experience. Catheter Cardiovasc Interv 2023; 101:243-249. [PMID: 36490226 DOI: 10.1002/ccd.30516] [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: 05/08/2022] [Revised: 10/19/2022] [Accepted: 11/19/2022] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Stent under-expansion due to calcification is associated with a less durable result. The development of intravascular lithotripsy (IVL) has provided clinicians with a readily available, simple-to-use treatment option for coronary calcification, but the use of IVL within a previously stented segment is currently off-license. There are, however, developing data suggesting that the use of IVL can be an effective treatment option for patients with calcific stent under-expansion. METHOD This was a single-center study of all patients treated with IVL for calcific stent under-expansion between January 2019 and June 2021. The impact of IVL on quantitative coronary angiography (QCA) stenosis and on the minimal stent area (MSA) derived from intracoronary imaging were recorded. The presence of periprocedural complications and adverse cardiovascular events was obtained from the clinical record during the study timeframe. RESULTS Thirty-nine patients underwent IVL for calcific stent under-expansion during the study time frame with one patient treated with more than one lesion in the same session. In all lesions, there was an improvement in the QCA stenosis with 37 (92.5%) having a residual stenosis of ≤30%. The mean QCA stenosis pre-IVL was 68 ± 21% and following IVL the mean QCA was 18 ± 9% (p < 0.001). In all lesions, there was an improvement in the MSA, with 26 (92.9%) achieving an MSA of more than 4.5 mm2. The mean MSA pre-IVL was 3.88 ± 1.51 mm2 and following IVL the mean MSA was 7.41 ± 2.34 mm2 (p < 0.001). There were no major procedural complications. Over a mean follow-up of 506 ± 277 days, one patient died from ventricular arrhythmia but there were no other major adverse cardiovascular events. CONCLUSION This single-center study demonstrates that IVL is a safe and effective treatment for calcific stent under-expansion with good medium-term results.
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Affiliation(s)
- Jonathan Hinton
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Mark Mariathas
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Elizabeth Chan
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Amit Patel
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Satnam Singh
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Vivek Kodoth
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Terry Levy
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Rosie Swallow
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Suneel Talwar
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Peter O'Kane
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
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Curini L, Pesce M. Shockwaves delivery for aortic valve therapy-Realistic perspective for clinical translation? Front Cardiovasc Med 2023; 10:1160833. [PMID: 37113704 PMCID: PMC10128859 DOI: 10.3389/fcvm.2023.1160833] [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: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Calcific aortic valve disease (CAVD) is the most frequent valvular heart disorder, and the one with the highest impact and burden in the elderly population. While the quality and standardization of the current aortic valve replacements has reached unprecedented levels with the commercialization of minimally-invasive implants and the design of procedures for valve repair, the need of supplementary therapies able to block or retard the course of the pathology before patients need the intervention is still awaited. In this contribution, we will discuss the emerging opportunity to set up devices to mechanically rupture the calcium deposits accumulating in the aortic valve and restore, at least in part, the pliability and the mechanical function of the calcified leaflets. Starting from the evidences gained by mechanical decalcification of coronary arteries in interventional cardiology procedures, a practice already in the clinical setting, we will discuss the advantages and the potential drawbacks of valve lithotripsy devices and their potential applicability in the clinical scenario.
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Spratt JC, Hung JD. Stent underexpansion in the CRUNCH registry: worth cracking? EUROINTERVENTION 2022; 18:529-530. [PMID: 36134685 PMCID: PMC10241270 DOI: 10.4244/eij-e-22-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- James C Spratt
- St George's, University of London, London, United Kingdom
| | - John D Hung
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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23
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Achim A, Alampi C, Krivoshei L, Leibundgut G. In vitro effect of intravascular lithotripsy on the polymer of a drug-eluting stent. EUROINTERVENTION 2022; 18:e333-e334. [PMID: 35775926 PMCID: PMC9980395 DOI: 10.4244/eij-d-22-00300] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alexandru Achim
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
| | - Carola Alampi
- BioEM Lab, Biozentrum, University of Basel, Basel, Switzerland
| | - Lian Krivoshei
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
| | - Gregor Leibundgut
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26
4410 Liestal, Switzerland
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Hayek A, Ly HQ, Avram R. Hitting the Rock Behind The Metal: Is Intravascular Lithotripsy for In-Stent Percutaneous Coronary Intervention The Perfect Symphony? Can J Cardiol 2022; 38:1476-1477. [PMID: 35716960 DOI: 10.1016/j.cjca.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Ahmad Hayek
- Montreal Heart Institute and Université de Montréal, Québec, Canada
| | - Hung Q Ly
- Montreal Heart Institute and Université de Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Avram
- Montreal Heart Institute and Université de Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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