Intravascular lithotripsy and temporary mechanical circulatory support for the treatment of heavily calcified coronary artery disease: insights from the BENELUX-IVL registry

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-05-12 DOI:10.1016/j.hrtlng.2025.04.030

Federico Oliveri MD , Isabel Merino MD , Martjn J.H. van Oort , Ibtihal Al Amri MD, PhD , Brian O. Bingen MD, PhD , Fatih Arslan 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 , Josè Montero-Cabezas MD, PhD.

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引用次数: 0

Abstract

Background

Intravascular lithotripsy (IVL) is increasingly utilized for the treatment of heavily calcified coronary lesions. However its use in conjunction with temporary mechanical circulatory support (tMCS) remains underexplored.

Objective

This study aims to evaluate the current use of tMCS and IVL for the treatment of heavily calcified coronary lesions.

Method

From the BENELUX-IVL prospective registry, patients who underwent IVL during PCI and required tMCS during the procedure were selected. The primary technical endpoint was procedural success <30%, defined as a composite of device success (the ability to deliver the IVL catheter across the target lesion, and delivery of IVL pulses without angiographic complications) with residual stenosis <30%, final Thrombolysis In Myocardial Infarction grade 3 flow, and no in-hospital major adverse cardiovascular events (MACE). The primary clinical outcome was in-hospital MACE, including cardiac death, non-fatal myocardial infarction, or target lesion revascularization.

Results

Between May 2019 and March 2024, a total of 454 patients were included, of whom 12 (2.6%) necessitated tMCS (for a total of 13 tMCS devices). Upon admission, the mean LV-EF was 39.5 ± 11.9%. The median Syntax score was 37 (25-49). A bail-out indication was the most common reason for tMCS initiation (58.3%), even if none was directly started due to IVL-related complications. Microaxial Flow Pump was the main utilized device (75%), followed by VA-ECMO (25%) and IABP (8.3%). One case required both VA-ECMO and Impella due to a coronary perforation complicated by cardiac tamponade. Procedural success < 30% was achieved in 91.6% of the cases. MACE occurred in one patient (8.3%).

Conclusion

In a large cohort of patients with complex heavily calcified coronary lesions requiring IVL, the need for tMCS was low (2.6%), with the main indication being bail-out.

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血管内碎石和临时机械循环支持治疗重度钙化冠状动脉疾病：来自BENELUX-IVL注册的见解

背景：血管碎石术（IVL）越来越多地用于治疗严重钙化的冠状动脉病变。然而，它与临时机械循环支持（tMCS）的结合使用仍未得到充分探索。目的评价tMCS和IVL在冠状动脉重度钙化病变治疗中的应用现状。方法从BENELUX-IVL前瞻性注册表中选择在PCI期间接受IVL并在手术期间需要tMCS的患者。主要技术终点是手术成功率（30%），定义为器械成功率（IVL导管穿过目标病变的能力，IVL脉冲的输送无血管造影并发症）残余狭窄率（30%），心肌梗死3级血流最终溶栓，无院内主要不良心血管事件（MACE）的综合。主要临床结局为院内MACE，包括心源性死亡、非致死性心肌梗死或靶病变血运重建术。结果2019年5月至2024年3月，共纳入454例患者，其中12例（2.6%）需要tMCS（共13个tMCS装置）。入院时，平均LV-EF为39.5±11.9%。语法得分中位数为37分（25-49分）。纾困指征是tMCS开始的最常见原因（58.3%），即使没有人是由于ivl相关并发症而直接开始的。微轴流泵是主要的使用设备（75%），其次是VA-ECMO（25%）和IABP（8.3%）。1例因冠状动脉穿孔合并心包填塞需要VA-ECMO和Impella。程序成功<；91.6%的病例达到30%。MACE发生1例（8.3%）。结论在大量需要IVL的复杂严重钙化冠状动脉病变患者中，tMCS的需求较低（2.6%），主要指征为救市。

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

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.