REPLICA-EPICA 18 Registry: Using IVL in Calcified Coronary Lesions

The presence of calcification in the coronary arteries (CAC) remains the main challenge in the percutaneous treatment of these lesions. Various studies have demonstrated the association of CAC with unfavorable long-term outcomes. Intravascular lithotripsy (IVL) has emerged as an effective tool for fracturing calcified plaques. Studies evaluating this strategy have shown high device success rates, with good clinical and angiographic outcomes. These, however, have not been randomized trials.

Dietas bajas en carbohidratos y progresión de la calcificación coronaria

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

The primary efficacy endpoint (PEP) was procedural success, defined as successful percutaneous coronary intervention (PCI) with residual stenosis <20% and no in-hospital complications (cardiac death, acute myocardial infarction [AMI], or need for target vessel revascularization [TVR]). The secondary safety endpoint (SEP) was the rate of major adverse cardiac events (MACE), defined as death, AMI, or TVR.

The study included a total of 426 patients with 456 lesions. The mean age was 73 years, and most patients were men. The most frequent clinical presentation was acute coronary syndrome (ACS), in 63% of cases. Most patients had good ventricular function (LVEF >50%), and transradial access was the most frequently used access (76%). The most affected coronary artery was the left anterior descending artery (44%), followed by the right coronary artery (31%), the circumflex artery (12%), and the left main coronary artery (11%).

Read also: Third Generation Balloon-Expandable and Self-Expanding Valves: TAVR Meta- Analysis.

Regarding the efficacy PEP, it was achieved in 66% of the patients, with similar rates between ACS patients (65%) and patients with chronic coronary syndromes (CCS) (68%). There were no significant differences in angiographic success after IVL between these two patient groups. As for the safety SEP, the 30-day MACE rate was 3%: it was 1% in CCS patients and 5% in ACS patients (p=0.073).

Conclusion

The use of IVL proved to be a feasible and safe procedure in a real-world patient population, effectively facilitating stent implantation in severely calcified lesions. ACS patients showed similar angiographic success rates but tended to have higher 30-day MACE rates compared with CCS patients. Long-term studies are needed to evaluate the clinical benefits associated with this therapeutic tool.

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

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | Asymptomatic Severe Aortic Stenosis: What Should Be our Approach?

Approximately 3% of the population over 65 years old has aortic stenosis. Current guidelines recommend valve replacement for patients with symptoms or an ejection...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...