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Deferred Intravascular Lithotripsy-Facilitated Stenting in ACS: Novel Approach to Improve PCI Outcomes in Severe Calcification?

ABSTRACT: Moderate/severe calcification, present in approximately one-third of culprit lesions in acute coronary syndromes (ACS), portends unfavorable procedural and post-primary percutaneous coronary intervention outcomes. Intravascular lithotripsy is a novel technique using shockwaves to fracture calcific plaques. Presenting a clinical case, we enumerate efficacy and safety parameters in using intravascular lithotripsy in ACS. (Level of Difficulty: Advanced.).

SUBMITTER: Patel S

PROVIDER: S-EPMC8312124 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Deferred Intravascular Lithotripsy-Facilitated Stenting in ACS: Novel Approach to Improve PCI Outcomes in Severe Calcification?

Patel Sanjay S Madhavan Mahesh V MV Spina Roberto R Figtree Gemma A GA Karimi Galougahi Keyvan K

JACC. Case reports 20200915 11

Moderate/severe calcification, present in approximately one-third of culprit lesions in acute coronary syndromes (ACS), portends unfavorable procedural and post-primary percutaneous coronary intervention outcomes. Intravascular lithotripsy is a novel technique using shockwaves to fracture calcific plaques. Presenting a clinical case, we enumerate efficacy and safety parameters in using intravascular lithotripsy in ACS. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 34317038

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Intravascular lithotripsy: A novel option for severe calcification of coronary artery.

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Effectiveness of Intravascular Lithotripsy on an Underexpanded Stent Due to Severe Calcification.

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Project description:The presence of severe right ventricular outflow tract calcification may preclude safe and effective transcatheter pulmonary valve replacement in patients with pulmonary allograft stenosis owing to the risk of conduit tear and suboptimal annular expansion. Debulking calcium using intravascular lithotripsy within the right ventricular outflow tract may mitigate this risk and improve valve hemodynamics. (Level of Difficulty: Advanced.).

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Drug-Coated Balloon Treatment for ACS Induced by Myocardial Bridging: An Intravascular Ultrasound-Guided PCI.

Project description:This report describes a case of a 35-year-old man who presented with acute coronary syndrome. An angiogram and intravascular ultrasound revealed atherosclerotic stenosis in the myocardial bridging segment of the mid-left anterior descending artery. The culprit lesion was treated using a drug-coated balloon, and no residual stenosis was observed, which was later confirmed by intravascular ultrasound and optical coherence tomography at a 1-year coronary angiographic follow-up. This case provides evidence that drug-coated balloon could be a potential treatment strategy for atherosclerosis located in the myocardial bridging segment and suggests advantages of the "leave nothing behind" strategy in such clinical scenarios.

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Intracoronary imaging-guided rotational atherectomy combined with intravascular lithotripsy in the treatment of severe coronary artery calcification-A case report.

Project description:BackgroundSevere coronary artery calcification increases the difficulty of percutaneous coronary intervention procedures and impairs stent expansion. Herein, we report a case of a patient who was successfully treated with rotational atherectomy using a stepped burr strategy combined with intravascular lithotripsy for plaque modification under intracoronary imaging.Case summaryA 65 year-old woman presented to our hospital with recurrent chest pain evolving for 1 year. Coronary angiography showed approximately 80% stenosis of the proximal mid-left anterior descending artery. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) revealed a 360° annular calcification. The calcification was rotablated with 1.5 and 1.75 burrs, and the lesion was undilatable with a 3.0 mm non-compliant balloon at 14 atm. Subsequently, the intravascular lithotripsy was reset for the modification of the calcified lesion. A shockwave balloon measuring 3.0 mm × 12 mm was delivered, and 40 pulses were performed at 6 atm. Intravascular imaging modalities (IVUS and OCT) revealed a circumferential calcified plaque with deep fractures. After post-balloon expansion followed by drug-eluting stent placement with a final stent expansion of 84%, there were no intraoperative complications and no major adverse cardiovascular events within 90 days postoperatively.ConclusionA combination of rotational atherectomy and intravascular lithotripsy may be an effective and complementary strategy for the treatment of severely calcified lesions that cannot be resolved using a single procedure. However, more clinical studies are required to clarify this finding.

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Intravascular lithotripsy modulates calcification without affecting lipid plaque contents in vivo: insights from near-infrared spectroscopy and intravascular ultrasound imaging

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Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial.

Project description:BackgroundEndovascular treatment of calcified peripheral artery lesions may be associated with suboptimal vessel expansion, increased complication risk, and reduced long-term patency. The primary endpoint from the Disrupt PAD III randomized controlled trial (RCT) demonstrated superior procedural success in patients treated with intravascular lithotripsy (IVL) vs percutaneous transluminal angioplasty (PTA). The present study evaluates primary patency after 1 and 2 years in this randomized population.MethodsThe Disrupt PAD III RCT enrolled 306 patients with moderately-to-severely calcified femoropopliteal arteries treated with IVL (n = 153) or PTA (n = 153) prior to DCB treatment or stenting. The powered secondary effectiveness endpoint was primary patency at 1 year, defined as freedom from clinically driven target lesion revascularization plus freedom from restenosis determined by duplex ultrasound. Acute PTA failure requiring stent placement during the index procedure was prespecified as a loss of primary patency.ResultsPrimary patency at 1 year was significantly greater in the IVL arm (80.5% vs 68.0%, P = .017). The requirement for provisional stenting was significantly lower in the IVL group (4.6% vs 18.3%, P < .0001). Freedom from clinically driven target lesion revascularization (IVL: 95.7% vs PTA: 98.3%, P = .94) and restenosis rates (IVL: 90.0% vs PTA: 88.8%, P = .48) were similar between the 2 groups at 1 year. At 2 years, primary patency remained significantly greater in the IVL arm (70.3% vs 51.3%, P = .003).ConclusionsThe Disrupt PAD III RCT secondary endpoint of superior 1-year primary patency was achieved, confirming the consistent safety and effectiveness of IVL followed by DCB treatment to facilitate a durable approach for patients with heavily calcified femoropopliteal arteries largely without stent requirement.

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The Coronary Intravascular Lithotripsy System.

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Project description:Intravascular lithotripsy (IVL) is a novel approach to lesion preparation of severely calcified plaques in coronary and peripheral vessels. Lithotripsy is delivered by vaporising fluid to create an expanding bubble that generates sonic pressure waves that interact with arterial calcification. Available data indicate that IVL leads to increased vessel compliance before stent implantation with high efficacy and an excellent safety profile. Since it gained the CE mark in 2017, and with improved operator experience, the use of IVL has expanded into more complex clinical situations. This review focuses on the best practice for IVL use in the cath lab, based on 3 years of experience with the technology and the latest scientific data from the Disrupt CAD clinical trials.

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