Intravascular lithotripsy for coral reef aortic stenosis: a case series assessing feasibility, hemodynamic effects,...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Surgery

Background:

• Coral reef aorta (CRA) involves calcified plaques obstructing the aorta, with open surgery posing high risks.
• Endovascular techniques, like intravascular lithotripsy (IVL), present less invasive options for treating aortic stenosis.
• High-risk patients often face significant morbidity with traditional surgical interventions.

Purpose of the Study:

• To assess the feasibility, safety, and hemodynamic effects of IVL guided by FFR in treating calcified aortic stenosis.
• To evaluate the efficacy of IVL in modifying calcified aortic plaques and restoring hemodynamic flow.
• To determine if IVL combined with FFR can reduce the need for stent implantation.

Main Methods:

• A case series of three patients with severe calcified abdominal aortic stenosis was conducted.
• Intravascular lithotripsy (IVL) was employed under fractional flow reserve (FFR) guidance.
• Pre- and post-procedural FFR measurements were utilized to assess hemodynamic significance and treatment outcomes.

Main Results:

• All IVL procedures were technically successful, with significant FFR improvements post-treatment.
• IVL effectively modified calcified plaques, achieving adequate luminal gain in most cases without stenting.
• One patient experienced an aortic dissection, managed successfully with stent placement.
• Follow-up showed sustained clinical improvement and vessel patency up to 12 months.

Conclusions:

• IVL combined with FFR is a feasible and effective minimally invasive strategy for managing heavily calcified aortic lesions.
• This combined approach allows for both plaque modification and objective physiological assessment.
• The IVL-FFR strategy shows potential for reducing stent implantation in treating calcified aortic stenosis.