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

Tepe, Gunnar; Brodmann, Marianne; Bachinsky, William; Holden, Andrew; Zeller, Thomas; Mangalmurti, Sarang; Nolte-Ernsting, C.; Virmani, Renu; Parikh, Sahil A.; Gray, William A.

doi:10.1016/j.jscai.2022.100341

Cited by 22 publications

(13 citation statements)

References 38 publications

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“…7 Recently a follow-up study to the Disrupt PAD III trial was published reporting on outcomes one and two years postoperatively. 12 Freedom from clinically driven target lesion revascularisation and lesion restenosis rates were statistically similar for both groups at the one and two year timepoints, but at the two year timepoint the difference in restenosis rates appears to grow in favour of IVL. 12 Long-term follow-up is needed to assess if this difference increases with time.…”

Section: Discussionmentioning

confidence: 85%

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report

Vancampenhout

Kerselaers

Aerden

et al. 2022

Vasc Endovascular Surg

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Heavily calcified arterial lesions are difficult to treat in an endovascular manner with conventional techniques due to limited arterial compliance. Intravascular lithotripsy offers a novel minimally invasive therapeutic option through endovascular emission of acoustic waves, fracturing calcium deposits and facilitating lesion dilation. We present the case of a successful application of the Shockwave intravascular lithotripsy system (IVL®, Shockwave Medical Inc) in a heavily calcified stenosis of the right renal artery in a patient with a coral reef aorta.

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Section: Discussionmentioning

confidence: 85%

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report

Vancampenhout

Kerselaers

Aerden

et al. 2022

Vasc Endovascular Surg

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“…Im Langzeitverlauf zeigte sich eine bis zu 2 Jahre anhaltende, verbesserte, primäre Offenheitsrate der IVL-Gruppe (74,4 % vs. 57,7 %) [13]. Allerdings ist dieser Unterschied einer Eigenheit dieser Studie geschuldet, die eine periinterventionelle Stentimplantation bereits als Therapieversager im Sinne einer Restenose bzw.…”

Section: Disrupt-pad-iii-studieunclassified

Endovaskuläre Therapie der pAVK – Therapieoptionen bei starker Verkalkung

Zeller

Noory

Beschorner

2023

Dtsch Med Wochenschr

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Was ist neu? Aktuelle Studiendaten Die randomisierte Disrupt-III-Studie verglich die intravaskuläre Lithotrypsie verkalkter Plaques zur Läsionsvorbereitung vor medikamentenbeschichteter Ballon-Angioplastie (DCB) mit einer Vordilatation mit einem herkömmlichen Ballon. Die einarmige REALITY-Studie untersuchte die direktionale Atherektomie zur Läsionsvorbereitung vor DCB-Angioplastie. Beide Studien zeigten, dass sich auch schwer verkalkte Stenosen und Verschlüsse der femoropoplitealen Arterie bis zu 30cm Länge erfolgreich mit einer geringen Stent-Implantationsrate behandeln lassen. Dies ist von besonderer Bedeutung, da sich in einer multivariaten Analyse eine Residualstenose > 30% nach DCB-Angioplastie als einziger unabhängiger Risikofaktor für eine Restenose erwiesen hat. Der potenzielle Nutzen der Lithotrypsie wurde auch in einer Studie an Zugangsarterien, die für die transfemorale Implantation von Aortenklappenprothesen benötigt werden, mit einer hohen Erfolgs- und niedrigen Komplikationsrate untersucht. Technisches Verfahren zur Behandlung verkalkter Plaques: Intravaskuläre Lithotrypsie (IVL) Die intravaskuläre Lithotrypsie ist eine neue Katheter-Technologie. Dabei wird über einen in der Stenose inflatierten Ballon-Katheter durch die Emission pulsatiler akustischer Stoßwellen die verkalkte Plaque frakturiert. Ziel ist, kalkbedingtes Recoil und Dissektionen zu reduzieren. Dieses Therapiekonzept wird aktuell neben der femoropoplitealen Strombahn in anderen Gefäßprovinzen wie Unterschenkel- und Beckenarterien in klinischen Studien erprobt.Atherektomie-Systeme sind bereits seit mehr als einer Dekade zur Therapie der pAVK etabliert, insbesondere die direktionale Atherektomie erlaubt es, exzentrische verkalkte Plaques gezielt zu entfernen. Klinische Studien untersuchen den möglicherweise additiven Effekt der Kombination einer mechanischen und biologischen Restenoseprophylaxe mittels DCB.

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“…Initial single arm studies of patients with heavily calcified lesions in the femoral and tibial arteries have demonstrated high rates of technical success with low complication rates and bailout stenting ( 61 – 63 ). Randomized studies are ongoing, with encouraging mid-term results at 1 year ( 64 ). While most attention has been focused on treatment of atherosclerotic intimal disease, studies by Brodmann et al have shown good early results when used in tibial lesions where calcification is more likely to be medial ( 64 ).…”

Section: Introductionmentioning

confidence: 99%

“…Randomized studies are ongoing, with encouraging mid-term results at 1 year ( 64 ). While most attention has been focused on treatment of atherosclerotic intimal disease, studies by Brodmann et al have shown good early results when used in tibial lesions where calcification is more likely to be medial ( 64 ).…”

Section: Introductionmentioning

confidence: 99%

Medial artery calcification in peripheral artery disease

Kim

Guzman

2023

Front. Cardiovasc. Med.

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Medial artery calcification (MAC) is a distinct, highly regulated process that is often identified in small and mid-sized arteries of the lower extremities. It is associated with advanced age, diabetes, and chronic kidney disease. MAC often occurs in conjunction with atherosclerotic occlusive disease in lower extremity arteries, and when seen together or in isolation, long-term limb outcomes are negatively affected. In patients with peripheral artery disease (PAD), the extent of MAC independently correlates with major amputation and mortality rates, and it predicts poor outcomes after endovascular interventions. It is associated with increased arterial stiffness and decreased pedal perfusion. New endovascular methods aimed at treating calcified lower-extremity lesions may improve our ability to treat patients with limb-threatening ischemia. Although recent developments have increased our understanding of the mechanisms contributing to MAC, further investigations are needed to understand the role of medial calcification in PAD, and to develop strategies aimed at improving patient outcomes.

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

Cited by 22 publications

References 38 publications

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report

Endovaskuläre Therapie der pAVK – Therapieoptionen bei starker Verkalkung

Medial artery calcification in peripheral artery disease

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