Safety and procedural outcomes of intravascular lithotripsy in calcified coronaries in Indian patients

Rao, Ravindra Singh; Sharma, Govind Narayan; Kunal, Shekhar; Garhwal, Kailash; Bajiya, Suresh; Mehta, Pawan

doi:10.1016/j.ihj.2022.01.001

Cited by 7 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, lumen loss and other clinical outcomes were similar at follow up of 9 months 58 . Rotational atherectomy has been now utilized in conjunction with DES to prepare severely calcified or fibrotic lesions that cannot be bridged or dilated properly by another balloon 55 …”

Section: Discussionmentioning

confidence: 91%

“…Our search revealed 636 possibly eligible articles for IVL use in coronary bed. After further elimination according to our inclusion and exclusion criteria, we included 38 studies 21–56 published from 2019 to 2023, comprising 2977 patients, in our meta‐analysis. The PRISMA flow diagram is illustrated in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…58 Rotational atherectomy has been now utilized in conjunction with DES to prepare severely calcified or fibrotic lesions that cannot be bridged or dilated properly by another balloon. 55 Finally, Lee et al discussed the orbital atherectomy modality in the ORBIT II trial for its efficacy and safety in proper lesion preparation.…”

Section: Meta-regression Analysismentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Sagris,

Ktenopoulos,

Dimitriadis

et al. 2024

Cathet Cardio Intervent

View full text Add to dashboard Cite

BackgroundWith heavily calcified coronary and peripheral artery lesions, lesion preparation is crucial before stent placement to avoid underexpansion, associated with stent thrombosis or restenosis and patency failure in the long‐term. Intravascular lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, making it to a promising tool for patients with severe calcification in coronary bed.AimsThe aim of the study is to systematically review and summarize available data regarding the safety and efficacy of IVL for lesion preparation in severely calcified coronary arteries before stenting.MethodsThis study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL, as well as stent implantation, were analyzed. The occurrence of major adverse cardiovascular events (MACE) was assessed using a random‐effects model.ResultsThis meta‐analysis comprised 38 studies including 2977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% (95% confidence interval [CI]: 91%−95%, I2 = 0%) and procedural success rate of 97% (95% CI: 95%−98%, I2 = 73.7%), while the in‐hospital and 30‐days incidence of MACE, myocardial infarction (MI), and death were 8% (95% CI: 6%−11%, I2 = 84.5%), 5% (95% CI: 2%−8%, I2 = 85.6%), and 2% (95% CI: 1%−3%, I2 = 69.3%), respectively. There was a significant increase in the vessel diameter (standardized mean difference [SMD]: 2.47, 95% CI: 1.77−3.17, I2 = 96%) and a decrease in diameter stenosis (SMD: −3.44, 95% CI: −4.36 to −2.52, I2 = 97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: −6.57, 95% CI: −7.43 to −5.72, I2 = 95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63−5.12, I2 = 96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10−4.37, I2 = 98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 and 1.94 ± 1.1 mm, respectively. Periprocedural complications were rare, with just a few cases of perforations, dissection, or no‐reflow phenomena recorded.ConclusionsIVL seems to be a safe and effective strategy for lesion preparation in severely calcified lesions before stent implantation in coronary arteries. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Sagris,

Ktenopoulos,

Dimitriadis

et al. 2024

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…2 Intracoronary imaging information contributes significantly to decision-making at every step of calcium modification and also helps in identifying complications such as dissections and intramural hematoma (IMH) to devise further treatment strategies. 3 Early data on IVL safety and efficacy showed acceptable procedural outcomes with minimal complications, such as dissections in 5% with no incidence of slow flow or no flow. 4, 5 Here, we report a case of calcified lesion in the proximal left circumflex artery (LCX) treated with IVL resulting in slow flow in the left anterior descending artery (LAD) owing to IMH extending retrogradely from the proximal LCX into the ostio-proximal LAD.…”

Section: Introductionmentioning

confidence: 97%

“Ischemia in Upstream Neighborhood” After Plaque Modification with Intravascular Lithotripsy

Reddy,

Premchand,

Krishna

et al. 2023

Indian Journal of Clinical Cardiology

View full text Add to dashboard Cite

Coronary artery calcification impacts outcomes after percutaneous coronary interventions owing to stent under expansion causing increased risk of stent thrombosis and restenosis. Therefore, adequate calcium modification before stent placement is the key to get desired outcomes in the patients with coronary artery calcification. Many devices are available for calcium modification, which includes orbital or rotational atherectomy, cutting balloon, scoring balloon, and intravascular lithotripsy. All these techniques have inherent risks of complications, such as coronary dissection, perforation, and slow or no reflow. We report a case of intravascular lithotripsy in calcified proximal left circumflex artery (LCX) lesion in a 63-year-old female leading to the left anterior descending artery (LAD) with no flow and ischemic ventricular tachycardia requiring DC cardioversion. Intravascular ultrasound from LAD revealed subintimal hematoma from ostium to mid LAD with intimal flap continuation into ostio-proximal LCX. The intimal flap in LAD has not showed any entry or exit tears which might increase the possibility of intramural hematoma shift to adjacent areas and branches leading to no reflow. Hence, cutting balloon fenestration of the intimal flap, followed by left main coronary artery bifurcation stenting was done to get a good result with flowing distal branches.

show abstract

Intravascular Lithotripsy for Calcified Left Main Artery Disease

Lee,

Kereiakes,

Shlofmitz

et al. 2023

Journal of the Society for Cardiovascular Angiography & Int

View full text Add to dashboard Cite

Safety and procedural outcomes of intravascular lithotripsy in calcified coronaries in Indian patients

Cited by 7 publications

References 29 publications

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta‐analysis

“Ischemia in Upstream Neighborhood” After Plaque Modification with Intravascular Lithotripsy

Intravascular Lithotripsy for Calcified Left Main Artery Disease

Contact Info

Product

Resources

About