Clinical outcomes of intravascular lithotripsy according to the timing of stent failure: Insights from the COIL registry.

Abstract

Background: Cumulative data has highlighted the efficacy of intra-vascular lithotripsy (IVL) in patients with stent failure (SF). However, it remains unclear whether the effectiveness of IVL, and subsequent clinical outcomes, are influenced by the timing of SF. We aimed to evaluate the outcomes of patients with SF undergoing IVL according to the age of index stent implantation.

Methods: This is a pre-specified subgroup analysis of the COIL registry (coronary intravascular lithotripsy in patients with stent failure), which included patients who underwent IVL treatment for SF, divided according to the timing of SF, i.e., early (≤12 months), mid-term (12-36 months), and late SF (>36 months). Procedural and clinical outcomes up to 12 months following IVL treatment were recorded. The primary endpoint was defined as the composite of cardiovascular death, spontaneous myocardial infarction, or target vessel revascularization (TVR).

Results: There were 88 patients included in this sub-study, of whom 40 (45%), 17 (19%), and 31 (35%) had early, mid-term, and late SF, respectively. Final procedural results were better in those with early compared to mid-term or late SF. At one-year follow-up, the incidence of the primary endpoint was associated with the timing of SF (8% vs. 12% vs. 29%, p = 0.042). The difference among the subgroups was driven by TVR (3% vs. 12% vs. 29%, p = 0.005).

Conclusions: Procedural and clinical outcomes following IVL treatment for patients with SF were influenced by the timing of index stent implantation. Further studies are needed to better understand the mechanisms behind recurrent SF.