Intravascular lithotripsy for severe coronary calcification: a systematic review.
Abdul, Fairoz Varma, Chetan Sharma, Vinoda
Abdul, Fairoz
Varma, Chetan
Sharma, Vinoda
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Affiliation
Sandwell and West Birmingham NHS Trust
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Publication date
2021-10-29
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Abstract
Introduction: Coronary artery calcification remains a challenge in percutaneous coronary interventions, due to the higher risk of suboptimal result with subsequent poor clinical outcomes. Intravascular lithotripsy is a novel way of treating severe coronary calcification as it has the ability to modify calcium both circumferentially as well as transmurally, facilitating stent expansion and apposition. We conducted a systematic overview of the published literature on intravascular lithotripsy (IVL) assessing the efficacy and feasibility of IVL in treating severe coronary calcification.
Evidence acquisition: Of the retrieved publications, 62 met our inclusion criteria and were included. A total of 1389 patients (1414 lesions) with significant coronary calcification or under-expanded stents underwent IVL.
Evidence synthesis: The mean age was 72.03 years (74.7% male). There was a significant improvement in acute and sustained vessel patency, with mean minimal lumen diameter of 2.78±0.46 mm, resulting in acute gain of 1.72±0.51 mm. The acute procedural success rate was 78.2 to 100% with in-hospital complication rate of 5.6 to 7.0%. The majority of the studies reported 30-day MACE, which was between 2.2 to 7.8%.
Conclusions: The recent studies have highlighted that the use of IVL with adjuvant intracoronary imaging has revolutionized the way of treating heavily calcified, non-dilatable coronary lesions and is likely to succeed the conventional ways of treating these complex lesions. We need further studies to gauge the long-term efficacy and safety of IVL against techniques currently available for calcium modification including conventional balloons, cutting or scoring balloons, rotational atherectomy and laser atherectomy.
Citation
Sheikh AS, Connolly DL, Abdul F, Varma C, Sharma V. Intravascular lithotripsy for severe coronary calcification: a systematic review. Minerva Cardiol Angiol. 2023 Dec;71(6):643-652.
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Article