Abstract

JACC

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TCTAP A-016

Clinical Experience Of 41 Consecutive Coronary Intravascular Lithotripsy Procedures In An Italian Cath-Lab

By Umberto Barbero, Marco Pavani, Matteo Ajassa, Cinzia Moncalvo, Michele De Benedictis

Presenter

Umberto Barbero

Authors

Umberto Barbero1, Marco Pavani1, Matteo Ajassa1, Cinzia Moncalvo1, Michele De Benedictis1

Affiliation

SS. Annunziata Hospital, Italy1
View Study Report
TCTAP A-016
Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)

Clinical Experience Of 41 Consecutive Coronary Intravascular Lithotripsy Procedures In An Italian Cath-Lab

Umberto Barbero1, Marco Pavani1, Matteo Ajassa1, Cinzia Moncalvo1, Michele De Benedictis1

SS. Annunziata Hospital, Italy1

Background

Stent under expansion is one of the main predictors of percutaneous coronary intervention (PCI) failure, being a trigger for both in-stent restenosis and stent thrombosis, with their obvious clinical impact. Among the main causes of stent failure, the presence of a severely calcified lesion is the most frequent and dangerous. Correct recognition and preparation of target lesion are therefore mandatory before stenting. Recently, the introduction into clinical practice of intravascular lithotripsy  (IVL) has enriched the interventional cardiologist’s tool-box for calcium treatment.

Methods

We enrolled all the patients treated with angioplasty and IVL (Shockwave Medical Inc, Santa Clara, USA) from October 2020 to October 2021 in our cath lab. Clinical and procedural characteristics were retrospectively collected during index admission after PCI. Each patient signed informed consent.

Results

We enrolled 35 patients (with 41 lesions treated with IVL). Mean age was 73 years old, 29 were males (82%). Twenty-one lesions (50%) were treated up-stream before stenting, 6 (16%) were bail-out IVL for inadequate stent expansion after post-dilation and 14 (37%) were in-stent restenosis with evidence of stent under-expansion because of the high burden of calcium. Sixty-six per cent of patients were treated in the context of Acute Coronary Syndrome (ACS). Sevent-three per cent of patient had three-vessel disease. The majority of procedure were done thruogh radial access (74%) and 79% of the stenosis was prepared with NC balloons (at least 2.5 mm diameter) before deployment of the IVL balloon; in 2 case IVL was done after rotational atherectomy. Intravascular ultrasound (IVUS) guidance was used in 15 pts. In just one patient the lesion was so long that 2 different IVL balloons were required; for the others, application of IVL cycles in different section of the lesion was sufficient to obtain adequate result. Two balloons were broken during lithotripsy. In 26 of 41 stenosis (63%) IVL delivery was obtained on a single wire, while 11 required buddy-wire (of whom 8 required child-in-mother technique to obtain adequate support for delivery). We had two major complications: 1 case of ventricular fibrillation (in a patients with recent myocardial infarction and severe reduction of ejection fraction, and 1 case of perforation at the time of inflation of the NC balloon after IVL easily treated with positioning of a covered stent which was easily delivered thanks to the previous IVL treatment).

Conclusion

Intravascular lithotripsy is a safe and all-around technique for treatment of severely calcified lesion in different clinical contexts from stable coronary artery disease to ACS, useful for upstream calcium treatment as well as bail-out stent optimization and correction of under expansion in calcified in-stent restenosis.

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