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Combined atherectomy and intravascular lithotripsy in calcified coronary lesions: a meta-analysis
Sahib Singh1, Aakash Garg2, Ukaya S Tantry3
1Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.
Insights
Combining atherectomy and intravascular lithotripsy (IVL) for severe coronary calcification is feasible, showing a 93% procedural success rate. While generally safe, it carries a low risk of complications like coronary perforation and adverse cardiovascular events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Severely calcified coronary lesions pose challenges for percutaneous coronary intervention (PCI).
- Limited data exists on the combined use of atherectomy and intravascular lithotripsy (IVL).
Purpose of the Study:
- To evaluate the pooled safety and efficacy of combined atherectomy and IVL.
- To assess clinical and procedural outcomes in treating calcified coronary lesions.
Main Methods:
- Systematic search of online databases for observational studies.
- Inclusion of studies using atherectomy (rotational, orbital, excimer laser) with IVL for PCI.
- Random-effects modeling to calculate pooled proportions of outcomes.
Main Results:
- 12 studies with 720 patients were analyzed.
- Pooled procedural success rate was 93%; coronary perforation occurred in 2.9%.
- Low incidences of myocardial infarction (2.0%), stroke (1.4%), and death (4.8%) were observed at follow-up.
Conclusions:
- Combined atherectomy and IVL is a feasible strategy for calcified coronary lesions.
- The approach demonstrates high procedural success but requires careful management of potential complications.
- Low rates of adverse cardiovascular events suggest a favorable risk-benefit profile.
Objectives:
Studies exploring the feasibility and safety of combined atherectomy and intravascular lithotripsy (IVL) for treatment of severely calcified coronary lesions are limited. The authors aimed to study the pooled evidence for the safety and efficacy of this combined approach in severely calcified coronary lesions and evaluate its clinical and procedural outcomes.
Methods:
Online databases were searched for studies using combined atherectomy (rotational, orbital, or excimer laser) and IVL during PCI for calcified coronary lesions. The outcomes of interest were acute procedural success, periprocedural complications, and cardiovascular (CV) events. Pooled proportions with 95% CI were calculated using a random-effects model.
Results:
A total of 12 observational studies with 720 patients were included. The mean age was 73 years, 76% were men, and 48% of the patients had an acute coronary syndrome. The pooled procedural success rate of combined atherectomy and IVL was 93% (95% CI, 89.56-96.25). Coronary perforation occurred in 2.9% (95% CI, 1.76-4.36) of the cases. Over a mean follow-up of 111 days, the incidence of CV outcomes was myocardial infarction 2.0% (95% CI, 0.67-3.93), stroke 1.4% (95% CI, 0.36-3.14), target vessel revascularization 2.2% (95% CI, 1.01-3.79), stent thrombosis 1.1% (95% CI, 0.21-2.84), major bleeding 5.8% (95% CI, 0.00-21.40), CV death 3.6% (95% CI, 1.53-6.42), and all-cause death 4.8% (95% CI, 2.75-7.33).
Conclusions:
Combined atherectomy and IVL for calcified coronary lesions is feasible with a high procedural success rate. However, there is a low but meaningful risk of procedural complications including coronary perforations, and a low risk of adverse CV events.
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