Combined atherectomy and intravascular lithotripsy in calcified coronary lesions: a meta-analysis.

Abstract

Objectives: Studies exploring the feasibility and safety of combined atherectomy and intravascular lithotripsy (IVL) for treatment of severely calcified coronary lesions are limited. The authors aimed to study the pooled evidence for the safety and efficacy of this combined approach in severely calcified coronary lesions and evaluate its clinical and procedural outcomes.

Methods: Online databases were searched for studies using combined atherectomy (rotational, orbital, or excimer laser) and IVL during PCI for calcified coronary lesions. The outcomes of interest were acute procedural success, periprocedural complications, and cardiovascular (CV) events. Pooled proportions with 95% CI were calculated using a random-effects model.

Results: A total of 12 observational studies with 720 patients were included. The mean age was 73 years, 76% were men, and 48% of the patients had an acute coronary syndrome. The pooled procedural success rate of combined atherectomy and IVL was 93% (95% CI, 89.56-96.25). Coronary perforation occurred in 2.9% (95% CI, 1.76-4.36) of the cases. Over a mean follow-up of 111 days, the incidence of CV outcomes was myocardial infarction 2.0% (95% CI, 0.67-3.93), stroke 1.4% (95% CI, 0.36-3.14), target vessel revascularization 2.2% (95% CI, 1.01-3.79), stent thrombosis 1.1% (95% CI, 0.21-2.84), major bleeding 5.8% (95% CI, 0.00-21.40), CV death 3.6% (95% CI, 1.53-6.42), and all-cause death 4.8% (95% CI, 2.75-7.33).

Conclusions: Combined atherectomy and IVL for calcified coronary lesions is feasible with a high procedural success rate. However, there is a low but meaningful risk of procedural complications including coronary perforations, and a low risk of adverse CV events.