Intravascular lithotripsy in saphenous vein grafts and graft stent failure: A case series

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Devices

Background:

• Saphenous vein grafts (SVGs) exhibit inferior long-term patency compared to arterial grafts, frequently necessitating revascularization via percutaneous coronary intervention (PCI).
• Percutaneous coronary intervention (PCI) in SVGs is challenging due to graft degeneration, particularly calcification in older grafts, and is associated with high stent failure rates.
• Intravascular lithotripsy (IVL) has proven effective for treating calcified coronary artery disease, but its application in SVG interventions remains largely unexplored.

Observation:

• This study presents the first case series detailing the use of IVL in five patients undergoing PCI for de novo SVG disease or SVG stent failure.
• The patients presented with varying degrees of SVG degeneration, with calcification being a significant factor in graft failure or stent restenosis.

Findings:

• Intravascular lithotripsy (IVL) was utilized as a calcium modification strategy prior to stenting in all five patients undergoing PCI for SVG disease.
• The procedure was technically successful in all cases, facilitating stent delivery and expansion in heavily calcified SVG lesions.
• No immediate procedural complications related to IVL use were reported.

Implications:

• These initial findings suggest that IVL may be a safe and effective option for treating calcified lesions within SVGs during PCI.
• Further research and larger studies are warranted to confirm the long-term efficacy and safety of IVL in SVG interventions.
• IVL could potentially improve PCI outcomes in patients with SVG disease, offering an alternative to suboptimal treatment strategies.