Intravascular lithotripsy for treatment of calcific coronary lesions in ST elevation myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• ST-elevation myocardial infarction (STEMI) often involves complex coronary artery disease.
• Calcified lesions pose a significant challenge during percutaneous coronary intervention (PCI), potentially leading to suboptimal stent expansion and adverse outcomes.
• Intravascular lithotripsy (IVL) is an emerging technology for treating calcified coronary lesions.

Purpose of the Study:

• To evaluate the utility and safety of intravascular lithotripsy (IVL) in primary PCI for STEMI.
• To assess IVL's effectiveness in modifying calcified culprit lesions.
• To determine the procedural success and early clinical outcomes associated with IVL use in STEMI patients.

Main Methods:

• Retrospective analysis of 72 patients undergoing primary PCI for STEMI across six UK sites.
• IVL was used for coronary calcium modification of culprit lesions (de-novo or in-stent restenosis) or under-expanded stents.
• Intracoronary imaging was used to assess stent expansion; procedural complications and 30-day Major Adverse Cardiovascular Events (MACE) were recorded.

Main Results:

• IVL was utilized in de-novo lesions (79%), in-stent restenosis (15%), and for under-expanded stents (6%).
• Average stent expansion was 104% in cases with available imaging (n=30).
• Intra-procedural stent thrombosis occurred in 1% and no-reflow in 4% of cases. 30-day MACE rate was 18%.

Conclusions:

• Intravascular lithotripsy (IVL) is feasible and safe for treating calcific coronary artery disease in the context of STEMI.
• IVL facilitates adequate stent expansion in complex calcified lesions during primary PCI.
• The study suggests IVL is a viable option for improving PCI outcomes in STEMI patients with significant coronary calcification.