Intravascular Lithotripsy as a Novel Treatment Method for Calcified Unprotected Left Main Diseases-Comparison to
Piotr Rola1,2, Jan Jakub Kulczycki3, Adrian Włodarczak1,3
1Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland.
Insights
Rotational Atherectomy (RA) and Shockwave-Intravascular-Lithotripsy (S-IVL) show promise for treating calcified Left Main disease. Both methods appear safe and effective, with similar outcomes in a small study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Unprotected calcified Left Main disease poses high risks during percutaneous coronary intervention (PCI).
- Effective lesion preparation is critical for successful PCI outcomes in Left Main disease.
- Rotational Atherectomy (RA) is established for plaque modification, but data in Left Main disease is limited.
- Shockwave-Intravascular-Lithotripsy (S-IVL) is a newer device for modifying calcified plaques.
Purpose of the Study:
- To evaluate the safety and effectiveness of Rotational Atherectomy (RA) versus Shockwave-Intravascular-Lithotripsy (S-IVL) for lesion preparation in calcified Left Main disease.
- To compare procedural outcomes and complications between RA and S-IVL in this high-risk patient subset.
Main Methods:
- Retrospective evaluation of 44 consecutive patients undergoing Left Main PCI.
- Patients were treated with either Rotational Atherectomy (RA) or Shockwave-Intravascular-Lithotripsy (S-IVL).
- Comparison of in-hospital and six-month Major Adverse Cardiovascular Events (MACE).
Main Results:
- The RA group included 29 patients (Syntax score 28.0 ± 7.5).
- The S-IVL group included 15 patients (Syntax score 23.3 ± 13.0).
- No significant differences in MACE were observed between RA and S-IVL groups at in-hospital (10.3% vs. 6.7%) or six-month follow-up (17.2% vs. 13.3%).
Conclusions:
- Both RA and S-IVL are potentially safe and effective strategies for managing calcified Left Main disease.
- Further research with larger cohorts and longer follow-up is needed to confirm the benefits of RA and S-IVL.
- These plaque modification techniques may improve PCI outcomes in complex Left Main stenosis.
Background:
The unprotected calcified Left Main disease represents a high-risk subset for percutaneous coronary intervention (PCI), and it is associated with a higher number of periprocedural complications and an increased rate of in-stent thrombosis and restenosis. Adequate lesion preparation plays a crucial role in achieving a favorable PCI outcome. Rotational Atherectomy (RA) is a well-established plaque-modifying method; nevertheless, the data regarding the effectiveness of RA in LM diseases is scarce. Recently, the novel ShockWave-Intravascular-Lithotripsy(S-IVL) device has been introduced to the PCI armamentarium in order to modify the calcified plaque.
Methods:
We performed a retrospective evaluation of 44 consecutive subjects who underwent the LM-PCI, and who were supported by either the RA or S-IVL.
Results:
The Rota group consisted of 29 patients with a mean syntax score of 28.0 ± 7.5. The S-IVL group was composed of 15 subjects with a syntax score of 23.3 ± 13.0 There were no statistical differences regarding MACE between the RA and Shockwave arms of the in-hospital group (10.3% vs. 6.7%), or in the six month (17.2% vs. 13.3%) follow-up group.
Conclusions:
RA and S-IVL could be safe and effective therapeutic strategies for calcified LM disease. Further studies with a higher number of participants and longer follow-up times are warranted to establish the potential benefits of RA and S-IVL for the management of LM stenosis.
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