Intravascular lithotripsy vs. rotational atherectomy on coronary microcirculation: a retrospective multicenter
Xi Zhang1,2,3, Peijian Wang4, Chenguang Li5
1Department of Cardiology, Yan'an Hospital of Kunming City, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China.
Insights
Intravascular lithotripsy (IVL) shows less coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) compared to rotational atherectomy (RA). IVL may better preserve microvascular function in patients with heavily calcified coronary lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) is a significant predictor of adverse outcomes in patients with coronary artery disease (CAD).
- The impact of intravascular lithotripsy (IVL) on CMD is not well-established.
- Direct comparisons between IVL and rotational atherectomy (RA) regarding CMD are lacking.
Purpose of the Study:
- To evaluate and compare coronary microvascular dysfunction (CMD) using angiographic microvascular resistance (AMR) after percutaneous coronary intervention (PCI) assisted by IVL versus RA.
- To assess the incidence of CMD and peri-procedural adverse events (PPAEs) in patients undergoing IVL-assisted versus RA-assisted PCI for heavily calcified coronary lesions.
Main Methods:
- A multicenter retrospective cohort study involving propensity score-matched patients (1:2 ratio) who underwent either RA- or IVL-assisted PCI.
- Primary outcomes included post-PCI AMR values and CMD incidence.
- Secondary outcomes focused on peri-procedural adverse events (PPAEs).
Main Results:
- In the matched cohort (140 RA vs. 70 IVL), post-PCI AMR was significantly lower in the IVL group compared to the RA group (2.26 ± 0.50 vs. 2.43 ± 0.35, p=0.015).
- The incidence of CMD was comparable between the IVL and RA groups (27.1% vs. 32.9%, p=0.398).
- Peri-procedural adverse events (PPAEs) trended lower in the IVL group, although not statistically significant (17.1% vs. 27.9%, p=0.088).
Conclusions:
- Intravascular lithotripsy (IVL) is associated with less post-procedural coronary microvascular dysfunction compared to rotational atherectomy (RA), as evidenced by lower angiographic microvascular resistance (AMR).
- These findings suggest IVL may offer benefits in preserving coronary microvascular function.
- Further large-scale prospective studies are warranted to confirm these results and explore the clinical implications across diverse patient populations.
Background:
Coronary microvascular dysfunction (CMD) predicts poor prognosis in patients with coronary artery disease (CAD). However, the impact of intravascular lithotripsy (IVL) on CMD remains unclear, and no studies have directly compared IVL and rotational atherectomy (RA) in the context of CMD.
Objective:
This study aimed to evaluate CMD, as indicated by angiographic microvascular resistance (AMR), in patients undergoing IVL- or RA-assisted PCI for heavily calcified coronary lesions.
Methods:
This multicenter retrospective cohort study enrolled patients underwent either RA- or IVL-assisted percutaneous coronary intervention (PCI) at three centers. Propensity score matching (1:2) was performed to control for potential bias. The primary outcomes included the post-PCI AMR values and CMD incidence. The secondary outcomes included peri-procedural adverse events (PPAEs).
Results:
A total of 377 patients were registered, and 210 propensity-matched patients (140 RA vs. 70 IVL) were analyzed. Pre-PCI AMR was similar between the groups (RA 1.24 ± 0.53 vs. IVL 1.28 ± 0.50, p = 0.615). Following PCI, AMR was significantly higher in the RA group compared to IVL (2.43 ± 0.35 vs. 2.26 ± 0.50, p = 0.015), while CMD incidence was comparable (RA 32.9% vs. IVL 27.1%, p = 0.398). In addition, the PPAEs rates were lower in the IVL group but the difference showed no statistical significance (27.9% vs. 17.1%, p = 0.088).
Conclusions:
IVL demonstrates less microvascular dysfunction compared to RA, as indicated by lower post-PCI AMR. These findings suggest that IVL may offer advantages in preserving coronary microvascular function across various clinical scenarios when both techniques are equally available and applicable, but further large-scale prospective studies are needed to verify these results.
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