Contemporary Evidence-Based Diagnosis and Management of Severe Coronary Artery Calcification

Doost, Ata; Rankin, James M.; Sapontis, James; Ko, Brian; Lo, S.; Jaltotage, Biyanka; Dwivedi, Girish; Wood, David; Byrne, Jonathan; Sathananthan, Janarthanan; Ihdayhid, Abdul Rahman

doi:10.1016/j.hlc.2022.01.011

Cited by 7 publications

(9 citation statements)

References 51 publications

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“…Coronary artery lesions with a high calcium burden still represent a challenging task for interventional cardiologists. Further, these lesions are connected with a greater risk of periprocedural complications, as well as with a late failure due to the stent underexpansion and malapposition, consequently resulting in poor clinical outcomes [ 20 , 21 , 22 ]. Heavily calcified coronary plaques, particularly those with deep calcium deposits, are commonly resistant to the standard plaque modification techniques, including the conventional balloon angioplasty.…”

Section: Discussionmentioning

confidence: 99%

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Rola

Furtan

Włodarczak³

et al. 2022

Biomedicines

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Background: Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy—a marriage of rotational atherectomy and intravascular lithotripsy—has recently been introduced to clinical practice as a novel therapeutic option. Methods: This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion. Results: The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified. Conclusions: Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.

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Section: Discussionmentioning

confidence: 99%

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Rola

Furtan

Włodarczak³

et al. 2022

Biomedicines

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“…There is a high risk of entanglement during the application of a Lacrosse nonslip element balloon 6 . The use of cutting and scoring balloons in severe calcification lesions and a lesion that standard predilated balloons cannot pass are limited 4,8 . ELCA has limited efficacy in severe calcification lesions and is not routinely recommended.…”

Section: Limitations Of Traditional Treatment Methodsmentioning

confidence: 99%

“…Computed tomography coronary angiography (CAG) is a noninvasive way to detect vascular calcification, but it provides finite value during the process of interventional therapy. In practice, the evaluation of calcified lesions relies more on CAG, intravascular ultrasound (IVUS), or optical coherence tomography (OCT) 4 …”

Section: Invasive Imaging Diagnosis Methodsmentioning

confidence: 99%

Intravascular lithotripsy: A novel option for severe calcification of coronary artery

Lv,

Li,

Ren

et al. 2023

Clinical Cardiology

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BackgroundSevere 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.HypothesisIVL may have great clinical application values and potential prospects.MethodBased 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.ResultsIVL has extremely high safety and effectiveness for severe coronary calcification compared with other ways, and structural improvements of IVL will further expand its value.ConclusionsThe emergence of IVL could set off a revolution in the treatment of coronary artery calcification.

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“…Traditional coronary calcium modifying techniques consist of (i) non-atherectomy techniques such as non-compliant (NC) balloons, ultra-high-pressure NC balloons, and cutting/scoring balloons and (ii) atherectomy techniques such as rotational/orbital atherectomy and Excimer Laser Coronary Atherectomy. 1 These technologies have some limitations, and there remains requirement for less invasive yet effective therapeutic modalities in recalcitrant calcified plaques.…”

Section: Introductionmentioning

confidence: 99%

A case of covered stent failure in sealing up a coronary perforation potentially related to intravascular lithotripsy treatment: insights from optical coherence tomography

Doost

Mabote

Clugston

et al. 2022

European Heart Journal - Case Reports

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Background Intravascular lithotripsy (IVL) is a new modality in treatment of calcified coronary lesions which improves procedural outcomes. Coronary perforation is an extremely uncommon but potentially catastrophic complication of percutaneous coronary intervention (PCI) and IVL therapy. Case Summary We report a case of an elective PCI to a calcified left anterior descending (LAD) and diagonal bifurcation lesion in a 65-year-old man. LAD was treated with two stents. Despite high pressure non-compliant balloon inflation, a focal area of under-expansion remained. IVL successfully treated the under-expansion but was complicated with a large coronary perforation. The perforation was successfully sealed with a PK-PAPYRUS covered stent sacrificing the diagonal branch. Patient remained stable until three hours later when he developed tamponade requiring urgent pericardial drainage. Repeat angiography demonstrated recanalization of the diagonal branch and ongoing contrast extravasation along its course. Optical coherence tomography intracoronary imaging was used to delineate the mechanism of ongoing bleeding. This demonstrated an interrupted elastic membrane of the covered stent, potentially caused by underlying fractured calcium. Therefore, a second overlying Papyrus stent was deployed which satisfactorily sealed the perforation. Discussion IVL is an emerging less invasive treatment for calcified coronary stenosis but could be associated with drastic complications. This case highlights the importance of awareness of IVL-related coronary perforation, and the potential limitation of new generation thinner-wall covered stents. Intracoronary imaging plays an important role in identifying mechanisms of stent failure, tailoring treatment, and optimising outcomes.

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Contemporary Evidence-Based Diagnosis and Management of Severe Coronary Artery Calcification

Cited by 7 publications

References 51 publications

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

Intravascular lithotripsy: A novel option for severe calcification of coronary artery

A case of covered stent failure in sealing up a coronary perforation potentially related to intravascular lithotripsy treatment: insights from optical coherence tomography

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