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

Abstract

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.

Orbital atherectomy for treatment of calcified coronary artery lesions. First experiences in Poland: Short-term outcomes of the Lower-Silesia Orbital Atherectomy Registry (LOAR)

“…The two remaining exceptions required additional plaque modification with S-IVL (orbital-lithotripsy). A similar bailout modality was described earlier in relation to rotational atherectomy [11,12]. Moreover, our study cohort contained a large number (19.4%) of highly demanding "uncrossable" lesions.…”

RotaTripsy Risk and Rewards: Findings from a Registry of Patients Undergoing Combined Rotational Atherectomy and Intravascular Lithotripsy

“…The in-hospital MI rate of 5.3% in our registry was grossly comparable to the 6.8% rate in DISRUPT CAD III, and in line with other RotaTripsy registries, but considerably higher than the RA cohorts (1.7% in ROTAXUS and 1% in PREPARE-CALC). 3,17,18,19 All in-hospital MI cases were detected immediately after the procedure and were deemed to be related to PCI.…”

“…No in-hospital mortalities were reported in the other RotaTripsy registries, despite them also recruiting a sizeable proportion of patients with ACS; however, care must be taken in drawing definitive comparisons from small sample sizes. 15,19 The high rates of MACE, MI and mortality may be explained by the fact that the strict requirements for combined RA and IVL select for a subset of patients with significant CAC. Patients with a high burden of CAC tend to have complex disease both anatomically and physiologically, which predisposes them to worse outcomes.…”

Safety and efficacy of a novel calcified plaque modification technique — Shockwave Intravascular Lithotripsy — in patients with coronary artery disease: Mid-term outcomes

“…The well-established balloon-dependent methods (such as non-compliance, cutting, scoring) [24] together with the atherectomy devices (both, rotational and orbital) [25,26] ensure that the success rate of the procedure can exceed 90%. A combination of the mentioned methods can result in an even higher success rate [27][28][29][30][31]. However, all of them have inherent limitations and may increase the risk of complications.…”