Shockwave Lithotripsy for Large Bore Access in Highly Calcified Iliac Arteries Prior to Transcatheter Aortic Valve Replacement

Kodali, Archana; Nazir, Raja; Schwartz, Brian

doi:10.1016/s0735-1097(20)33355-6

Journal of the American College of Cardiology

2020

DOI: 10.1016/s0735-1097(20)33355-6

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Shockwave Lithotripsy for Large Bore Access in Highly Calcified Iliac Arteries Prior to Transcatheter Aortic Valve Replacement

Archana Kodali

Raja Nazir

Brian Schwartz

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“…Iliac artery calcification is the primary reason for abandoning the TF approach to TAVR. 10,11 Small (n=42) multicenter registry data have shown promising results with successful TAVR in all patients with treated vessels. It is worthwhile to note that in this group of patients, 80% received 14 Fr sheaths, likely chosen because of the smaller diameter and deliverability in calcified and tortuous anatomies.…”

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confidence: 99%

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Payabyab

Elbaum

Sharma

et al. 2021

US Cardiology Review

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Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise.

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confidence: 99%

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Payabyab

Elbaum

Sharma

et al. 2021

US Cardiology Review

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Use of intravascular lithotripsy in non-coronary artery lesions

Umeh,

Stratton,

Wagner

et al. 2023

World J Cardiol

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Aspirin, other antiplatelet agents, and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases. A concomitant proton pump inhibitor (PPI) treatment is often prescribed in these patients, as gastrointestinal complications are relatively frequent. On the other hand, a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs; in particular, it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel, due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism. Previously, the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged. In contrast, it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel, new P2Y12 receptor antagonists. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids, or non-steroidal anti-inflammatory drugs, and Helicobacter pylori (H. pylori ) infection. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could be recommended, even if their usefulness deserves further data. H. pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease (with or without complication) treated with antithrombotic drugs. The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors, anticoagulants, and PPIs, discussing consequent clinical implications.

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Shockwave Lithotripsy for Large Bore Access in Highly Calcified Iliac Arteries Prior to Transcatheter Aortic Valve Replacement

Cited by 2 publications

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Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Use of intravascular lithotripsy in non-coronary artery lesions

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