Intravascular Lithotripsy for Calcified Left Main Artery Disease

Lee, Michael S.; Kereiakes, Dean J.; Shlofmitz, Richard A.; Shlofmitz, Evan; Mintz, Gary S.; Ali, Ziad A.; Park, Duk-Woo; Park, Seung-Jung

doi:10.1016/j.jscai.2023.101126

Cited by 1 publication

(1 citation statement)

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“…The mechanism of action involves the generation of an electric spark by IVL, which causes the mixed liquid in the balloon to vaporize, forming bubbles. These bubbles expand and collapse rapidly, exerting disruptive forces on the calcified plaques [ 1 ]. The Disrupt CAD series studies [ 2 – 5 ], encompassing a total of 626 patients, demonstrated no reflow or slow flow.…”

Section: Introductionmentioning

confidence: 99%

Extension of interval between adjacent pulse delivery cycles to deal with myocardial ischemia by intravascular lithotripsy: case report

Lv,

Li,

Ren

et al. 2024

J Cardiothorac Surg

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Background Intravascular lithotripsy (IVL) represents a novel approach in the management of coronary calcification. This technique employs acoustic pressure waves, generated by a shockwave balloon, to effectively fracture both superficial and deep calcification in situ. The efficacy and safety of IVL have been convincingly demonstrated through the Disrupt CAD I-IV studies. While IVL is associated with the occurrence of atrial and ventricular arrhythmias, there is no evidence to indicate it causes myocardial ischemia. Case Description A 71-year-old man was admitted presenting with chest pain. His previous coronary angiography revealed stenosis and calcification in the left anterior descending branch. An attempt to predilate the lesion using two Lacrosse non-slip element balloons was unsuccessful. Ventricular premature beats and transient ST-segment depression were captured during the utilization of IVL. The operator gradually extended the pulse emission interval across two consecutive cycles to mitigate myocardial ischemia. Notably, when the interval reached 30s, the patient had no chest pain or ST-segment changes. Subsequent images of intravascular ultrasound confirmed calcification ruptures. Therapeutic intervention included the placement of a stent and the application of a drug-coated balloon in the left anterior descending branch. A telephonic follow-up six months later indicated the patient had no discomfort. Conclusions This case underscores the effectiveness of gradually extending the pulse emission interval as a strategic complement to the clinical application of IVL. In certain clinical scenarios, it may become imperative to suspend the pulse delivery to improve myocardial blood supply.

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Section: Introductionmentioning

confidence: 99%