Efficacy and Safety of Intravascular Lithotripsy Versus Rotational Atherectomy in Balloon-Crossable Heavily Calcified Coronary Lesions

Mousa, Mohamed; Bingen, Brian O.; Amri, Ibtihal Al; Mertens, B.J.A.; Taha, Salma; Tohamy, Aly; Youssef, Amr Ahmed Aly; Jukema, J. Wouter; Montero-Cabezas, José M.

doi:10.1016/j.carrev.2022.10.011

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Our search revealed 636 possibly eligible articles for IVL use in coronary bed. After further elimination according to our inclusion and exclusion criteria, we included 38 studies 21–56 published from 2019 to 2023, comprising 2977 patients, in our meta‐analysis. The PRISMA flow diagram is illustrated in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Sagris,

Ktenopoulos,

Dimitriadis

et al. 2024

Cathet Cardio Intervent

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BackgroundWith heavily calcified coronary and peripheral artery lesions, lesion preparation is crucial before stent placement to avoid underexpansion, associated with stent thrombosis or restenosis and patency failure in the long‐term. Intravascular lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, making it to a promising tool for patients with severe calcification in coronary bed.AimsThe aim of the study is to systematically review and summarize available data regarding the safety and efficacy of IVL for lesion preparation in severely calcified coronary arteries before stenting.MethodsThis 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 before stent implantation. The diameter of the vessel lumen before and after IVL, as well as stent implantation, were analyzed. The occurrence of major adverse cardiovascular events (MACE) was assessed using a random‐effects model.ResultsThis meta‐analysis comprised 38 studies including 2977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% (95% confidence interval [CI]: 91%−95%, I2 = 0%) and procedural success rate of 97% (95% CI: 95%−98%, I2 = 73.7%), while the in‐hospital and 30‐days incidence of MACE, myocardial infarction (MI), and death were 8% (95% CI: 6%−11%, I2 = 84.5%), 5% (95% CI: 2%−8%, I2 = 85.6%), and 2% (95% CI: 1%−3%, I2 = 69.3%), respectively. There was a significant increase in the vessel diameter (standardized mean difference [SMD]: 2.47, 95% CI: 1.77−3.17, I2 = 96%) and a decrease in diameter stenosis (SMD: −3.44, 95% CI: −4.36 to −2.52, I2 = 97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: −6.57, 95% CI: −7.43 to −5.72, I2 = 95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63−5.12, I2 = 96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10−4.37, I2 = 98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 and 1.94 ± 1.1 mm, respectively. Periprocedural complications were rare, with just a few cases of perforations, dissection, or no‐reflow phenomena recorded.ConclusionsIVL seems to be a safe and effective strategy for lesion preparation in severely calcified lesions before stent implantation in coronary arteries. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.

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Section: Resultsmentioning

confidence: 99%

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Sagris,

Ktenopoulos,

Dimitriadis

et al. 2024

Cathet Cardio Intervent

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“…A meta-analysis including seven studies comparing the short-term outcomes of RA and OA revealed that RA is associated with a higher risk of in-hospital and 30-day MI, but a lower prevalence of coronary artery dissection and perforation. Additionally, RA was associated with a longer procedural fluoroscopy time [85,86].…”

Section: Periprocedural Complications and Short-term Outcomesmentioning

confidence: 99%

“…In terms of IVL and RA, there are comparisons claiming that IVL is less expensive due to its lower overall resource use [100,101]. There are also differences between studies concerning radiation levels between IVL and RA [85,100]. It is necessary to adapt these data to specific regions, as the price of equipment can vary between them.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Rotational Atherectomy, Orbital Atherectomy, and Intravascular Lithotripsy Comparison for Calcified Coronary Lesions

Florek,

Bartoszewska,

Biegała

et al. 2023

JCM

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In order to improve the percutaneous treatment of coronary artery calcifications (CAC) before stent implantation, methods such as rotational atherectomy (RA), orbital atherectomy (OA), and coronary intravascular lithotripsy (IVL) were invented. These techniques use different mechanisms of action and therefore have various short- and long-term outcomes. IVL employs sonic waves to modify CAC, whereas RA and OA use a rapidly rotating burr or crown. These methods have specific advantages and limitations, regarding their cost-efficiency, the movement of the device, their usefulness given the individual anatomy of both the lesion and the vessel, and the risk of specified complications. This study reviews the key findings of peer-reviewed articles available on Google Scholar with the keywords RA, OA, and IVL. Based on the collected data, successful stent delivery was assessed as 97.7% for OA, 92.4% for IVL, and 92.5% for RA, and 30-day prevalence of MACE (Major Adverse Cardiac Events) in OA—10.4%, IVL—7.2%, and RA—5%. There were no significant differences in the 1-year MACE. Compared to RA, OA and IVL are cost-effective approaches, but this is substantially dependent on the reimbursement system of the particular country. There is no standard method of CAC modification; therefore, a tailor-made approach is required.

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“…There were also two coronary perforations in the RA group and one coronary perforation in the IVL group. 28 In a recent study, functional outcomes of IVL and RA were compared in 210 patients. The IVL group had greater reductions in in-stent pressure gradients demonstrated with fractional flow reserve.…”

Section: Ivl Versus Other Contemporary Calcium-modifying Techniquesmentioning

confidence: 99%

“…However, the median fluoroscopy time was shorter in the IVL group. There were also two coronary perforations in the RA group and one coronary perforation in the IVL group 28 . In a recent study, functional outcomes of IVL and RA were compared in 210 patients.…”

Section: Ivl Versus Other Contemporary Calcium‐modifying Techniquesmentioning

confidence: 99%

Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Gruslova,

Inanc,

Cilingiroglu

et al. 2023

Cathet Cardio Intervent

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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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Efficacy and Safety of Intravascular Lithotripsy Versus Rotational Atherectomy in Balloon-Crossable Heavily Calcified Coronary Lesions

Cited by 5 publications

References 22 publications

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Rotational Atherectomy, Orbital Atherectomy, and Intravascular Lithotripsy Comparison for Calcified Coronary Lesions

Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

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