Procedural and clinical impact of intracoronary lithotripsy in heavily calcified aorto-ostial coronary lesions

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-23 DOI:10.1002/ccd.31233

Federico Oliveri MD, Maura Meijer MSc, Martijn J. H. Van Oort MSc, Ibtihal Al Amri MD, PhD, Brian O. Bingen MD, PhD, Bimmer E. Claessen MD, PhD, Aukelien C. Dimitriu-Leen MD, PhD, Joelle Kefer MD, PhD, Hany Girgis MD, Tessel Vossenberg MD, PhD, Frank Van der Kley MD, PhD, J. Wouter Jukema MD, PhD, Jose M. Montero-Cabezas MD, PhD

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引用次数: 0

Abstract

Background

Percutaneous coronary intervention of calcified aorto-ostial lesions (AOL) pose unique challenges due to anatomical propensity for recoil, leading to poorer outcomes compared to non-AOL. Although intravascular lithotripsy (IVL) has shown excellent success and safety in heavily calcified plaques, evidence specific to AOL is limited. This study aims to evaluate the efficacy and safety of IVL in AOL versus non-AOL.

Methods

Patients treated with IVL between 2019 and 2023 from an ongoing prospective multicenter registry were eligible for inclusion. Patients were therefore classified in AOL and non-AOL groups, based on anatomical location. The primary technical endpoint was device success, defined as the ability to deliver the IVL catheter and pulses at the target lesion, without angiographic complications. Secondary technical endpoint encompassed procedural success <30%, consisting of device success with residual stenosis <30%, final thrombolysis in myocardial infarction grade 3 flow, and no in-hospital major adverse cardiovascular events (MACE). The primary clinical endpoint was in-hospital MACE, including cardiac death, nonfatal myocardial infarction, or target lesion revascularization.

Results

A total of 321 patients underwent IVL, including 48 with AOL. Device success showed no significant difference between AOL and non-AOL groups (100% vs. 98.2%; p = 0.35). A nonsignificant trend toward worse procedural success with residual stenosis <30% was observed in the AOL arm (AOL 81.3% vs. non-AOL 90.5%, p = 0.06). In-hospital MACE was significantly higher in AOL (4.2% vs. 0.7%, p = 0.048), attributed entirely to cardiac deaths. At 6-month follow-up, the incidence of MACE (AOL 8.3% vs. non-AOL 4.0%, p = 0.19), and cardiac deaths (AOL 4.2% vs non-AOL1.1%, p = 0.11) were comparable between groups.

Conclusion

IVL treatment for heavily calcified AOL demonstrates comparable procedural and 6-month clinical outcomes when compared to non-AOL, despite a higher incidence of in-hospital MACE.

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冠状动脉内碎石术对严重钙化的冠状动脉主干病变的手术和临床影响。

背景：经皮冠状动脉介入治疗钙化的主动脉-肋骨病变（AOL）具有独特的挑战性，因为解剖学上的反冲倾向会导致与非 AOL 相比更差的治疗效果。虽然血管内碎石术（IVL）在重度钙化斑块中显示出了极佳的成功率和安全性，但专门针对 AOL 的证据却很有限。本研究旨在评估IVL在AOL与非AOL中的疗效和安全性：方法：2019 年至 2023 年期间接受 IVL 治疗的患者均符合纳入条件，这些患者来自一个正在进行的前瞻性多中心登记处。因此，根据解剖位置将患者分为AOL组和非AOL组。主要技术终点是设备成功率，即在靶病变处输送 IVL 导管和脉冲的能力，且无血管造影并发症。次要技术终点包括手术成功率：共有 321 名患者接受了 IVL，其中 48 人接受了 AOL。AOL组和非AOL组的设备成功率无明显差异（100% vs. 98.2%; p = 0.35）。残余狭窄导致手术成功率降低的趋势并不明显：IVL治疗严重钙化的AOL与非AOL相比，尽管院内MACE发生率较高，但手术和6个月临床结果相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.