Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Strategy in Management of Heavily Calcified Coronary Vessels - A Case-series of the Use of Shockwave Coronary Intravascular Lithotripsy
Chi Kit Yu1
Tuen Mun Hospital, Hong Kong, China1
The presence of calcium in the coronary artery affects the outcome of percutaneous coronary intervention (PCI). One of the latest technologies is Shockwave coronary intravascular coronary lithotripsy (IVL) in which sonic pressure is emitted to crack the calcium in the coronary artery.
This was a retrospective, multicenter case series which investigated patients who received IVL. Their baseline clinical characteristics, lesion characteristics, procedure details, and outcomes were analysed. The clinical outcomes during the index hospitalization and at 3 month were analysed. Potential challenges of IVL as well the pros and cons of other techniques for tackling calcified lesions were discussed.
44 patients and 67 lesions were analysed. The average length of lesion was 31.7 ± 8.40 mm and the average stenosis percentage was 79.4 ± 13.4%. 77.6% of lesions were Type C lesions and 82.1% were severely calcified lesions. Success in stent delivery and IVL deployment occurred in 97.7% of patients. There were no coronary artery perforation, slow flow, closure or cardiac death during the index hospitalization. MACE occurred in 2.3% of patients within the index hospitalization. For the 3-month safety outcome, myocardial infarction and cardiac death occurred in 2.3% of patients and MACE occurred in 4.5% of patients.
In this retrospective case-series, Shockwave IVL was able to demonstrate a high procedural success rate with a low rate of complication. However, more data are needed to compare the safety and clinical outcomes of IVL with other therapies.