Abstract

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-054

Shockwave Intravascular Lithotripsy as a Novel Strategy for the Treatment of Stent Underexpansion Caused by Calcified Plaques

By Wojciech Wanha, Mariusz Tomaniak, Jacek Bil, Rafal Januszek, Rafał Wolny, Maksymilian Opolski, Łukasz Kuźma, Adam Janas, Tomasz Figatowski, Łukasz Lewicki, Jakub Kulczycki, Adrian Wlodarczak, Brunon Tomasiewicz, Sylwia Iwańczyk, Jerzy Sacha, Łukasz Koltowski, Miłosz Dziarmaga, Miłosz Jaguszewski, Bartosz Olajossy, Krzysztof Dyrbuś, Krzysztof Reczuch, Robert Gil, Sławomir Dobrzycki, Janusz Kochman, Andrzej Ochala, Adam Witkowski, Maciej Lesiak, Fabrizio D'Ascenzo, Sławomir Bartuś, Wojciech Wojakowski

Presenter

Wojciech Wańha

Authors

Wojciech Wanha1, Mariusz Tomaniak2, Jacek Bil3, Rafal Januszek4, Rafał Wolny2, Maksymilian Opolski2, Łukasz Kuźma5, Adam Janas6, Tomasz Figatowski7, Łukasz Lewicki8, Jakub Kulczycki9, Adrian Wlodarczak9, Brunon Tomasiewicz10, Sylwia Iwańczyk11, Jerzy Sacha12, Łukasz Koltowski2, Miłosz Dziarmaga11, Miłosz Jaguszewski7, Bartosz Olajossy13, Krzysztof Dyrbuś1, Krzysztof Reczuch10, Robert Gil3, Sławomir Dobrzycki5, Janusz Kochman2, Andrzej Ochala1, Adam Witkowski14, Maciej Lesiak11, Fabrizio D'Ascenzo, Sławomir Bartuś17, Wojciech Wojakowski1

Affiliation

Medical University of Silesia, Poland1, Medical University of Warsaw, Poland2, Centre for Postgraduate Medical Education, Poland3, University Hospital in Cracow, Poland4, Medical University of Białystok, Poland5, American Heart of Poland, Poland6, Medical University of Gdansk, Poland7, Department of Invasive Cardiology, Wejcherowo, Poland, Poland8, Miedziowe Centrum Zdrowia S.A., Poland9, Wroclaw Medical University, Poland10, Poznan University of Medical Sciences, Poland11, University of Opole, Poland12, 1st Military Clinical Hospital, Poland13, National Institute of Cardiology, Poland14, Jagiellonian University Medical College, Poland17
View Study Report
TCTAP A-054
Imaging: Intravascular

Shockwave Intravascular Lithotripsy as a Novel Strategy for the Treatment of Stent Underexpansion Caused by Calcified Plaques

Wojciech Wanha1, Mariusz Tomaniak2, Jacek Bil3, Rafal Januszek4, Rafał Wolny2, Maksymilian Opolski2, Łukasz Kuźma5, Adam Janas6, Tomasz Figatowski7, Łukasz Lewicki8, Jakub Kulczycki9, Adrian Wlodarczak9, Brunon Tomasiewicz10, Sylwia Iwańczyk11, Jerzy Sacha12, Łukasz Koltowski2, Miłosz Dziarmaga11, Miłosz Jaguszewski7, Bartosz Olajossy13, Krzysztof Dyrbuś1, Krzysztof Reczuch10, Robert Gil3, Sławomir Dobrzycki5, Janusz Kochman2, Andrzej Ochala1, Adam Witkowski14, Maciej Lesiak11, Fabrizio D'Ascenzo, Sławomir Bartuś17, Wojciech Wojakowski1

Medical University of Silesia, Poland1, Medical University of Warsaw, Poland2, Centre for Postgraduate Medical Education, Poland3, University Hospital in Cracow, Poland4, Medical University of Białystok, Poland5, American Heart of Poland, Poland6, Medical University of Gdansk, Poland7, Department of Invasive Cardiology, Wejcherowo, Poland, Poland8, Miedziowe Centrum Zdrowia S.A., Poland9, Wroclaw Medical University, Poland10, Poznan University of Medical Sciences, Poland11, University of Opole, Poland12, 1st Military Clinical Hospital, Poland13, National Institute of Cardiology, Poland14, Jagiellonian University Medical College, Poland17

Background

Whereas the efficacy and safety of intravascular lithotripsy(IVL) have been confirmed in de novo calcified coronary lesions, little is known about its utility in treating stent under expansion.

Methods

The IVL-Dragon Registry was a multicenter study that enrolled consecutive patients with stent under expansion treated with IVL in high-volume PCI centers. The procedural success (primary efficacy endpoint) was, defined as a relative stent expansion >80%. Thirty days device-oriented composite endpoint(DOCE) (defined as a composite of cardiac death, target lesion revascularization, or target vessel myocardial infarction) was the secondary endpoint.

Results

A total of 62 patients were enrolled. The primary efficacy endpoint was achieved in 72.6% of patients. Both stent underexpansion 58.5% (47.5-69.7) vs. 11.4% (5.8-20.7),p<0.001 and the stenotic area 82.6% (72.4-90.8) vs. 21.5% (11.1-37.2),p<0.001 measured by quantitative coronary angiography improved significantly after IVL. Intravascular imaging confirmed increased stent expansion following IVL from 37.5% (16.0-66.0) to 86.0%(69.2-90.7), p<0.001 by optical coherence tomography and from 57.0% (31.5-77.2) to 89.0%(85.0-92.0), p=0.002 by intravascular ultrasound. Secondary endpoint occurred in one(1.6%) patient caused by cardiac death. There was no target lesion revascularization or target vessel myocardial infarction during 30-days follow-up.

Conclusion

In this real-life, largest to date analysis of IVL use to manage under expanded stent, IVL presented as an effective and safe modality to facilitate stent expansion and luminal gain. Our findings warrant a larger, prospective study with long-term clinical outcomes adjudication to confirm IVL use as an emerging first-line therapeutic option to treat stent under expansion.

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