Use of IVL in Calcified Coronary Lesions in a Real World Population

The presence of calcification in coronary arteries (CAC) remains a challenge for the percutaneous treatment of these lesions. Several studies have established the link between CAC and poor long term results.  Intravascular lithotripsy (IVL) has surged as a tool to induce calcified plaque fracture.  Even though studies on this strategy are not randomized, they have shown high success rates for this device with good clinical and angiographic results. 

Dietas bajas en carbohidratos y progresión de la calcificación coronaria

The aim of this prospective, multicenter study was to assess the safety and efficacy of IVL in calcified lesions in a real world cohort of consecutive patients. 

The efficacy primary outcome was defined as procedural success, that is, successful PCI with residual stenosis <20%, with no in-hospital complications (cardiac death, acute myocardial infarction or need for target vessel revascularization (TVR)). The safety secondary end point was major adverse cardiac events (MACE), defined as death, acute MI, or TVR.

It included 426 patients (456 lesions), mean age 73, with a higher prevalence of men. The most common clinical presentation was acute coronary syndrome (ASC) in 63% of cases. Most patients presented good ventricular function (EF >50%), and the transradial approach was the most used (76%). The most affected coronary artery was the anterior descending (44%), followed by the right coronary (31%), the circumflex (12%) and the left main (11%).

Read also: Lithotripsy in the Left Main Coronary Artery.

As regards the safety end point, it was reached in 66% of patients, with similar rates between ACS patients (65%) and those with chronic coronary syndrome (CCS) (68%). In addition, there were no significant differences in angiographic success after IVL between these two groups of patients. As regards the safety end point, the 30-day MACE rate resulted 3%: 1% in CCS patients and 5% ACS patients (p=0.073).

Conclusion

The use of IVL was shown feasible and safe in a real world population, facilitating the effective stenting of severe calcified lesions. Even though ACS patients showed angiographically similar rates, they showed a trend towards higher 30-day MACE vs. CCS patients. More long term studies are required to assess the clinical benefits associate to this therapeutic tool. 

Dr. Andrés Rodríguez

Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.

Original Title: A Prospective, Multicenter, Real-World Registry of Coronary Lithotripsy in Calcified Coronary Arteries The REPLICA-EPIC18 Study.

Reference: Oriol Rodriguez-Leor, MD, PHD et al J Am Coll Cardiol Intv 2024.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Measuring Post-TAVI Gradients and Their Implications: Are Invasive and Echocardiographic Assessments Comparable?

Transcatheter aortic valve implantation (TAVI) is considered the treatment of choice for a significant proportion of patients with symptomatic aortic stenosis. Outcomes have improved...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...