Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy

Gallinoro, Emanuele; Monizzi, Giovanni; Sonck, Jeroen; Candreva, Alessandro; Mileva, Niya; Nagumo, Sakura; Munhoz, Daniel; Buytaert, Dimitri; Mastrangelo, Angelo; Andreini, Daniele; Galli, Stefano; Bartorelli, A.; Barbato, Emanuele; Bruyne, Bernard De; Collet, Carlos

doi:10.1016/j.ijcard.2022.01.066

Cited by 6 publications

(4 citation statements)

References 23 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%

“…51 However, it was linked to a higher incidence of perforations (0.8% in cutting-baloon vs. 0% in standard PCI) and difficulties in balloon delivery. 52 Although Scheller et al found that scoring balloon was quite effective for treating coronary in-stent restenosis, no randomized trial comparing it to the cutting balloon has been conducted. 53 Rotational atherectomy, was very effective in resistant CTO with a success rate up to 92.6% (N = 25/27) in an earlier study by Wen et al 54 In addition, the PREPARE-CALC trial showed among 200 patients with severely calcified coronary lesions that rotational atherectomy achieved stent deliverability in 98% of cases compared to 81% with balloon modification techniques.…”

Section: Meta-regression Analysismentioning

confidence: 99%

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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%

Section: Meta-regression Analysismentioning

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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“…All these characteristics led to great obstacles in the process of PCI, particularly in the era of percutaneous transluminal coronary angioplasty and bare metal stent, and usually resulted in failure or inadequate post-expansion following stenting. Modern technology has provided new tools to treat these calcified lesions, including cutting balloons, rotation, laser ablation, and intravascular lithotripsy (IVL) ( 24 ), which helps in post-expansion after stent installation. All these developments can improve the prognosis of such patients and change their choice of revascularization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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BackgroundThe primary cause of death among maintenance dialysis patients is coronary artery disease (CAD). However, the best treatment plan has not yet been identified.MethodsThe relevant articles were retrieved from various online databases and references from their inception to October 12, 2022. The studies that compared revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] with medical treatment (MT) among maintenance dialysis patients with CAD were selected. The outcomes evaluated were long-term (with a follow-up of at least 1 year) all-cause mortality, long-term cardiac mortality, and the incidence rate of bleeding events. Bleeding events are defined according to TIMI hemorrhage criteria: (1) major hemorrhage, intracranial hemorrhage or clinically visible hemorrhage (including imaging diagnosis) with decrease of hemoglobin concentration ≥5 g/dl; (2) minor hemorrhage, clinically visible bleeding (including imaging diagnosis) with a drop in hemoglobin of 3–5 g/dl; (3) minimal hemorrhage, clinically visible bleeding with hemoglobin drop <3 g/dl. In addition, revascularization strategy, CAD type, and the number of diseased vessels were considered in subgroup analyses.ResultsA total of eight studies with 1,685 patients were selected for this meta-analysis. The current findings suggested that revascularization was associated with low long-term all-cause mortality and long-term cardiac mortality but a similar incidence rate of bleeding events compared to MT. However, subgroup analyses indicated that PCI is linked to decreased long-term all-cause mortality compared to MT but CABG did not significantly differ from MT in terms of long-term all-cause mortality. Revascularization also showed lower long-term all-cause mortality compared to MT among patients with stable CAD, single-vessel disease, and multivessel disease but did not reduce long-term all-cause mortality among patients with ACS.ConclusionLong-term all-cause mortality and long-term cardiac mortality were reduced by revascularization in comparison to MT alone in patients undergoing dialysis. Larger randomized studies are needed to confirm the conclusion of this meta-analysis.

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“…The IVL group had greater reductions in in-stent pressure gradients demonstrated with fractional flow reserve. 29 In summary, IVL appears to have greater procedural success and reduction in fluoroscopy time, although more studies are still needed.…”

Section: Ivl Versus Other Contemporary Calcium-modifying Techniquesmentioning

confidence: 92%

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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Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy

Cited by 6 publications

References 23 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

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

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

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