Procedural and clinical impact of intravascular lithotripsy for the treatment of peri-stent calcification.

Fecha de publicación: 21/10/2023 Fecha Ahead of Print: 21/10/2023

Autores de IIS La Fe

• Jorge Sanz Sánchez

  Autor

Participantes ajenos a IIS La Fe

• van Oort, Martijn J H
• Al Amri, Ibtihal
• Bingen, Brian O.
• -Soriano, Juan G. Cordoba
• Karalis, Ioannis
• Oliveri, Federico
• van der Kley, Frank
• Jukema, J. Wouter
• Jurado-Roman, Alfonso
• Montero-Cabezas, Jose M.

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

Abstract

BACKGROUND: Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. METHODS: Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. RESULTS: Of 101 patients (71.2±9.2years), 56(55%) received in-stent IVL for late stent failure (median 109days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45%) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6-89.8]% to 16.4 [10.4-26.9]%;p<0.0001 and 28.6[22.5-43.3]% to 14.1[10.3-29.4]%;p<0.0001, and minimum lumen area (MLA) (3.4±1.2 to 8.6±2.5mm2;p<0.002 and 5.4±1.9 to 7.3±1.9;p<0.0001).Device(98%) and procedural success(80%) were high. MACE rates in-hospital (2%), 30-days (3%),6-months(5%) and 1-year(7%) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1±0.7mm vs. 0.5±0.4mm;p<0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6-89.8] vs. 28.6[22.5-43.3]%; p<0.0001 and MLA (3.4±1.2 vs 5.4±1.9mm2; p<0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4-26.9) vs. 14.1(10.3-29.4);p=0.914) and MLA (8.6±2.5vs. 7.4±1.9mm2;p=0.064) in late- and immediate-IVL were comparable. CONCLUSIONS: IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords

• Calcific coronary artery disease; In-stent; Lithotripsy