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Intravascular lithotripsy in peripheral lesions with severe calcification and its use in TAVI procedure - a
Marios Sagris1, Nikolaos Ktenopoulos1, Stergios Soulaidopoulos1
1First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Insights
Intravascular Lithotripsy (IVL) effectively treats calcified peripheral arteries, improving vessel diameter and reducing stenosis with a low complication rate. This technology also shows promise for Transcatheter Aortic Valve Implantation (TAVI) procedures.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
- Vascular Surgery
Background:
- Heavily calcified peripheral artery lesions pose significant challenges during catheter-based interventions.
- Intravascular Lithotripsy (IVL) uses sonic pressure waves to disrupt subendothelial calcification, offering a novel plaque modification approach.
- IVL is a promising technique for managing severe calcification in peripheral arteries.
Purpose of the Study:
- To systematically review and summarize data on the safety and efficacy of IVL for preparing calcified peripheral arteries.
- To evaluate the utility of IVL in Transcatheter Aortic Valve Implantation (TAVI) procedures.
- To assess peri-procedural complications associated with IVL in peripheral vasculature.
Main Methods:
- Systematic literature search of PubMed, SCOPUS, and Cochrane databases up to February 23, 2023, adhering to PRISMA guidelines.
- Analysis of 20 studies involving 1,223 patients with heavily calcified peripheral lesions.
- Estimation of luminal diameter changes and assessment of complications using a random-effects model.
Main Results:
- IVL demonstrated 100% successful delivery, significantly increasing luminal diameter and reducing diameter stenosis in 1,223 patients.
- A low complication rate was observed, with 97% of procedures free from dissection; dissections occurred in 6% of patients.
- In TAVI subgroup analysis, IVL assistance achieved 100% successful implantation with only 4% experiencing dissections.
Conclusions:
- IVL is a safe and effective technique for modifying severely calcified peripheral artery lesions.
- IVL shows significant promise as a modality to aid in Transcatheter Aortic Valve Implantation (TAVI).
- Further prospective studies are warranted to validate these findings.
Abstract:
Background: Heavily calcified peripheral artery lesions increase the risk of vascular complications, constituting a severe challenge for the operator during catheter-based cardiovascular interventions. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and represents a promising technique for plaque modification in patients with severe calcification in peripheral arteries. Purpose: Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified peripheral arteries and its use in Transcatheter Aortic Valve Implantation (TAVI). Patients and methods: This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL in the peripheral vasculature. The diameter of the vessel lumen before and after IVL was estimated. The occurrence of peri-procedural complications was assessed using a random-effects model. Results: 20 studies with a total of 1,223 patients with heavily calcified peripheral lesions were analysed. The mean age of the cohort was 70.6 ± 17.4 years. Successful IVL delivery achieved in 100% (95% CI: 100%-100%, I2 = 0%), with an increase in the luminal diameter (SMD: 4.66, 95% CI: 3.41-5.92, I2 = 90.8%) and reduction in diameter stenosis (SMD: -4.15, 95% CI: -4.75 to -3.55, I2 = 92.8%), and a concomitant low rate of complications. The procedure was free from dissection in 97% (95% CI: 91%-100%, I2 = 81.4%) while dissections of any type (A, B, C, or D) were observed in 6% (95% CI: 2%-10%, I2 = 85.3%) of the patients. Several rare cases of abrupt closure, no-reflow phenomenon, perforation, thrombus formation, and distal embolization were recorded. Finally, the subgroup analysis of patients who underwent a TAVI with IVL assistance presented successful implantation in 100% (95% CI: 100%-100%, I2 = 0%) of the cases, with only 4% (95% CI: 0%-12%, I2 = 68.96%) presenting dissections of any sort. Conclusions: IVL seems to be an effective and safe technique for modifying severely calcified lesions in peripheral arteries and it is a promising modality in TAVI settings. Future prospective studies are needed to validate our results.
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