Related Experiment Video
Updated: Jul 15, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Comparison of patients undergoing protected high risk percutaneous coronary intervention using either intravascular
Tobias T Krause1, Shazia S Afzal1, Anida Gjata1
1Department of Cardiology, Hospital of the Brothers of Mercy Trier, Trier, Germany.
Insights
Intravascular lithotripsy plus percutaneous mechanical circulatory support (pMCS) demonstrated improved hemodynamic stability and reduced catecholamine use in high-risk PCI patients. Protected PCI with IVL and pMCS showed a lower rate of major adverse cardiac events compared to rotational atherectomy.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Medicine
Background:
- Heavily calcified vessels pose significant challenges in patients with impaired left ventricular ejection fraction.
- Percutaneous mechanical circulatory support (pMCS) is increasingly utilized in high-risk percutaneous coronary intervention (HRPCI).
Purpose of the Study:
- To compare the efficacy and safety of intravascular lithotripsy (IVL) combined with pMCS versus rotational atherectomy (RA) combined with pMCS in patients undergoing HRPCI.
- To evaluate peri-interventional hemodynamic stability and major adverse cardiac events (MACE) in this patient population.
Main Methods:
- A retrospective registry study involving 25 patients undergoing protected HRPCI.
- Patients received either IVL + pMCS (n=11) or RA + pMCS (n=14).
- Primary endpoint: peri-interventional hemodynamic stability; Secondary endpoint: MACE.
Main Results:
- The IVL + pMCS group exhibited significantly higher mean arterial pressure (MAP) post-procedure and required fewer post-interventional catecholamines.
- While the change in MAP was not significant, the proportion of patients needing catecholamines was lower in the IVL group (p=0.02).
- Major adverse cardiac events (MACE) occurred less frequently in the IVL + pMCS group (0% vs. 20%, p=0.046).
Conclusions:
- Patients treated with IVL + pMCS demonstrated enhanced hemodynamic stability and reduced need for catecholamines.
- pMCS as a bailout strategy was linked to increased in-hospital mortality.
- The slow-reflow phenomenon was associated with long-term all-cause mortality.
Background:
Treating heavily calcified vessels is a challenging task in patients with an impaired left ventricular ejection fraction. Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients in high-risk percutaneous coronary intervention (HRPCI).
Methods:
In this retrospective registry, we investigated 25 patients undergoing a protected HRPCI receiving either intravascular lithotripsy (IVL + pMCS; n = 11) or rotational atherectomy (RA + pMCS; n = 14). The primary endpoint was defined as peri-interventional hemodynamic stability. The secondary endpoint was defined as major adverse cardiac events (MACE).
Results:
Patients in the IVL + pMCS group had a significantly higher mean arterial pressure (MAP) at the end of the procedure (p = 0.04). However, the Δ-change in MAP was not significant [-12 mmHg (±20.3) vs. -16.1 mmHg (±23.9), p = 0.709]. The proportion of patients requiring post-interventional catecholamines was significantly lower in the IVL + pMCS group (p = 0.02). The Δ-change in Syntax Score was not significant between groups (IVL + pMCS -22 (±5.8) vs. RA + pMCS -21.2 (±7.6), p = 0.783). MACE did occur less in the group of IVL + pMCS (0% vs. 20%, p = 0.046). Patients with pMCS insertion as a bailout strategy had a higher probability for in-hospital death (p < 0.001) and the occurrence of the slow-reflow phenomenon was associated with long-term mortality (p = 0.021) in the cox regression analysis.
Conclusions:
In our cohort patients in the IVL + pMCS group were hemodynamically more stable which led to a lower rate of catecholamine usage. pMCS as a bailout strategy was associated with in-hospital death and the occurrence of the slow reflow phenomenon with all-cause mortality during follow-up.
More Related Videos
08:12Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
