Intravascular Lithotripsy Versus Rotational Atherectomy in Coronary Chronic Total Occlusions: Analysis from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention Registry.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-10-24 DOI:10.1016/j.amjcard.2024.10.018
Pedro E P Carvalho, Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Ozgur Selim Ser, James W Choi, Sevket Gorgulu, Farouc A Jaffer, Raj Chandwaney, Khaldoon Alaswad, Mir B Basir, Lorenzo Azzalini, Ramazan Ozdemir, Mahmut Uluganyan, Jaikirshan Khatri, Laura Young, Paul Poommipanit, Nazif Aygul, Rhian Davies, Oleg Krestyaninov, Dmitrii Khelimskii, Omer Goktekin, Ahmet Akyel, Hasim Tuner, Nidal Abi Rafeh, Ahmed Elguindy, Bavana V Rangan, Olga C Mastrodemos, Konstantinos Voudris, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis
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Abstract

There are limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024. Of 15,690 patients who underwent CTO PCI during the study period, 436 (2.78%) underwent IVL and 381 (2.45%) RA. Patients treated with IVL had more co-morbidities and more complex CTO lesions. Antegrade wiring was the most used initial and successful crossing strategy for lesions treated with both IVL and RA, although the retrograde approach was more frequently used in IVL cases. Procedure and fluoroscopy times, and air kerma radiation doses and contrast volumes, were greater in patients treated with RA than those treated with IVL. There were no significant differences between the groups in technical success (97.2% vs 95.3%, p = 0.20), procedural success (94.7% vs 91.8%, p = 0.14), and in-hospital major adverse cardiac events (MACEs) (3.0% vs 4.2%, p = 0.47). However, coronary artery perforations were more frequent in patients who underwent RA (9.5% vs 3.2%, p <0.001). Multivariable logistic regression analysis revealed that IVL compared with RA was not independently associated with technical success, procedural success, or in-hospital MACE. In patients who undergo CTO PCI, IVL is associated with similar in-hospital MACE, technical success, and procedural success but lower incidence of coronary artery perforation compared with RA.

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冠状动脉慢性完全闭塞症中的血管内碎石术与旋转充质切除术:PROGRESS-CTO 登记分析。
背景:在慢性全闭塞(CTO)经皮冠状动脉介入治疗(PCI)过程中使用斑块修饰设备的比较数据有限:我们比较了2019年至2024年期间在50个美国和非美国中心接受CTO PCI患者的血管内碎石术(IVL)和旋转动脉瘤切除术(RA)的病变准备情况:在研究期间接受CTO PCI治疗的15690名患者中,436人(2.78%)接受了IVL治疗,381人(2.45%)接受了RA治疗。接受IVL治疗的患者合并症更多,CTO病变更复杂。对于接受IVL和RA治疗的病变,逆行布线是最常用的初始和成功穿越策略,但在IVL病例中逆行布线更为常见。与IVL相比,RA治疗患者的手术和透视时间以及空气凯玛辐射剂量和造影剂用量都更高。两组在技术成功率(97.2% 对 95.3%,P=0.20)、手术成功率(94.7% 对 91.8%,P=0.14)和院内重大心脏不良事件(MACE)(3.0% 对 4.2%,P=0.47)方面无明显差异。然而,接受RA治疗的患者冠状动脉穿孔的发生率更高(9.5%对3.2%,P=0.14):在接受 CTO PCI 的患者中,与 RA 相比,IVL 与相似的院内 MACE、技术成功率和手术成功率相关,但冠状动脉穿孔发生率较低。
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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