Intravascular lithotripsy for severe coronary calcification: a systematic review.

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Coronary artery calcification poses challenges in percutaneous coronary interventions, leading to suboptimal results and poor outcomes.
• Intravascular lithotripsy (IVL) offers a novel approach to modify severe coronary calcification, enhancing stent expansion and apposition.

Approach:

• A systematic literature review was conducted, including 62 publications.
• Data from 1389 patients (1414 lesions) treated with IVL for severe coronary calcification or under-expanded stents were analyzed.

Key Points:

• IVL treatment in 1389 patients demonstrated significant improvements in acute and sustained vessel patency.
• Mean minimal lumen diameter increased to 2.78±0.46 mm, with an acute gain of 1.72±0.51 mm.
• Procedural success rates ranged from 78.2% to 100%, with in-hospital complications between 5.6% and 7.0% and 30-day Major Adverse Cardiovascular Events (MACE) between 2.2% and 7.8%.

Conclusions:

• Intravascular lithotripsy (IVL), especially with intracoronary imaging, is revolutionizing the treatment of heavily calcified coronary lesions.
• IVL is poised to supersede conventional methods for treating complex calcified lesions.
• Further studies are required to evaluate the long-term efficacy and safety of IVL compared to other calcium modification techniques.