Coronary intravascular lithotripsy: Experience and outcome in real-world patients (about 70 cases)

Abstract

Introduction

Coronary intravascular lithotripsy (CIVL) is an increasingly popular technique to treat severely calcified coronary artery disease.

Objective

In this study, we aimed to assess and qualify the indications, modalities, and outcomes of CIVL in real-world patients.

Method

This was a retrospective single-center study. We included all patients in which CIVL was indicated and attempted between April 2022 and December 2023. Electronic medical records were used to gather demographic, clinical, and angiographic data. Follow-up data was collected using telephone calls to patients that survived the index hospitalization without complication.

Results

Seventy patients were included, with a ratio of one lesion per patient. The cohort was elderly, with a mean age of 76.9 ± 9.3 years old, and predominantly male (78.6%). The most common cardiovascular risk factor was arterial hypertension (65.7%). Clinical presentations were varied, mostly non-ST-segment elevation myocardial infarction (29.7%), chronic coronary syndrome (25%), and ST-segment elevation myocardial infarction (14.1%). The mean procedural time was 65.6 ± 28.1 minutes and the mean fluoroscopy time was 25.7 ± 13.6 minutes, with a mean contrast volume injected of 170.3 ± 71.6 mL. The left anterior descending was the most common artery treated (44.3%), followed by the right coronary artery (34.3%). Proximal lesions were most common (42.9%). The mean balloon diameter was 3.3 ± 0.5 mm, with a stent diameter of 3.4 ± 0.5 mm. The mean number of stents was 1.5 ± 0.7, with a total length of 34.6 ± 18.6 mm. In 8.3% of patients, CIVL was used as a bailout strategy for stent underexpansion. Among outcomes, we recorded an angiographic success rate of 92.9% and one case of coronary perforation (1.4%). In 5.7% of cases, the operator was unable to cross the lesion with the balloon, with 2.9% requiring rotational atherectomy. The cardiovascular death rate was 7.1%, with no cases of myocardial infarction, stroke, or target vessel revascularization. Fig. 1 summarizes the main results.

Conclusion

Although the target population is older, with more comorbidities, CIVL seems to be an effective strategy for the treatment heavily calcified lesions, with an acceptable complication rate.