Intravascular imaging–guided intracoronary lithotripsy: First real‐world experience

Abstract

Background and Aims Coronary calcification remains a significant challenge for the contemporary interventional cardiologist. We aim to describe the use of intravascular lithotripsy (IVL) in a range of real‐world settings. Methods A retrospective two‐center analysis of patients treated with IVL between June 2018 and November 2019. Technical and procedural success, as well as procedural complications and 30‐day outcomes (death, myocardial infarction, or repeat target vessel revascularization), was recorded. Results Sixty‐five patients underwent IVL: 80% were male and the mean age was 70.1 ± 12.0 years. 54% of patients presented with acute coronary syndrome (ACS) and 68% of patients had intracoronary imaging. Twelve patients required IVL within pre‐existing stents, and 12 underwent IVL in the left main stem. All balloons were successfully delivered with 98.5% procedural success. There was a significant gain in MLA post PCI of 261.9 ± 100% following IVL. There were two procedural complications. At 30‐day follow‐up, there was one death, and one patient required a repeat procedure due to stent underexpansion. Conclusions In this largest real‐world series of imaging‐guided IVL for calcified lesions to date, we demonstrate that IVL is deliverable, safe, and effective at calcium modification especially when intracoronary imaging is used.

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

“…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.…”

Coronary Intravascular Lithotripsy Effectiveness and Safety in a Real-World Cohort

“…The catheter, similar to an over-the-wire angioplasty balloon, is available in 2.5-4.0 mm diameter, with a set length of 12 mm [1]. The IVL catheter should be selected at a 1:1 ratio relative to the target-vessel diameter and after a sub-nominal pressure inflation, the emitters produce electric sparks that create vapor bubbles in the surrounding fluid (saline/contrast), that expand and collapse within the balloon, resulting in unfocused acoustic pressure waves that radiate circumferentially and transmurally, with an effective pressure of 50 atmospheres [3,8,19]. This results in multiplane micro/macro fractures in the calcified plaque, that leads to an increase in vascular compliance [1].…”

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

“…Despite the well-established safety and efficiency of the atherectomy devices, utilization in the ACS subset is burdened with worse outcomes compared to stable patients [ 26 , 27 ]. Due to the novelty of the shockwave device, the evidence supporting the use of S-IVL in the ACS subset comes mainly from case reports, studies or low-number registries, which is encouraging [ 28 , 29 , 30 , 31 , 32 ]. However, in some rare cases, the combination of the use of debulk devices and non-compliant balloon catheter lesion preparations is insufficient in order to achieve an adequate stent expansion.…”