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Minerva Cardiology and Angiology 2021 Oct 29

DOI: 10.23736/S2724-5683.21.05776-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intravascular lithotripsy for severe coronary calcification: a systematic review

Azeem S. SHEIKH , Derek L. CONNOLLY, Fairoz ABDUL, Chetan VARMA, Vinoda SHARMA

Department of Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK


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INTRODUCTION: Coronary artery calcification remains a challenge in percutaneous coronary interventions, due to the higher risk of suboptimal result with subsequent poor clinical outcomes. Intravascular lithotripsy is a novel way of treating severe coronary calcification as it has the ability to modify calcium both circumferentially as well as transmurally, facilitating stent expansion and apposition. We conducted a systematic overview of the published literature on intravascular lithotripsy (IVL) assessing the efficacy and feasibility of IVL in treating severe coronary calcification.
EVIDENCE ACQUISITION: Of the retrieved publications, 62 met our inclusion criteria and were included. A total of 1389 patients (1414 lesions) with significant coronary calcification or under-expanded stents underwent IVL.
EVIDENCE SYNTHESIS: The mean age was 72.03 years (74.7% male). There was a significant improvement in acute and sustained vessel patency, with mean minimal lumen diametre of 2.78 ± 0.46 mm, resulting in acute gain of 1.72 ± 0.51 mm. The acute procedural success rate was 78.2 to 100% with in-hospital complication rate of 5.6 to 7.0%. The majority of the studies reported 30-day MACE, which was between 2.2 to 7.8%.
CONCLUSIONS: The recent studies have highlighted that the use of IVL with adjuvant intracoronary imaging has revolutionized the way of treating heavily calcified, non-dilatable coronary lesions and is likely to succeed the conventional ways of treating these complex lesions. We need further studies to gauge the long-term efficacy and safety of IVL against techniques currently available for calcium modification including conventional balloons, cutting or scoring balloons, rotational atherectomy and laser atherectomy.


KEY WORDS: Intravascular lithotripsy; IVL; Calcified coronary arteries; Complex coronary intervention; Coronary calcification; Calcium - modification techniques

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