Wong Bernard, El-Jack Seif, Newcombe Ruth, Glenie Timothy, Armstrong Guy, Khan Ali
North Shore Hospital, 124 Shakespeare Rd, Takapuna, Auckland 0620, New Zealand.
J Invasive Cardiol. 2019 Mar;31(3):46-48. doi: 10.25270/jic/19.00048. Epub 2019 Feb 15.
Calcified coronary lesions often cause suboptimal stent expansion, which is one of the greatest predictors of adverse outcomes such as stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical, Inc) is a recently approved technique used in the treatment of heavily calcified coronary lesions. We present our early real-world experience with the S-IVL device.
All patients treated with S-IVL between October 2018 and January 2019 during their percutaneous coronary intervention (PCI) at our center were included.
During this period, a total of 26 patients undergoing PCI were treated with S-IVL prior to stent deployment (69% male; age, 72 ± 8 years). Indications for PCI were acute coronary syndromes (ACS) in 14 patients (54%), stable angina in 11 patients (42%), and PCI before transcatheter aortic valve implantation in 1 patient (4%). Seventy-one percent of the ACS cases undergoing PCI with S-IVL were to the perceived ACS culprit lesion during the index procedure, while 29% were staged PCIs to severe non-culprit lesions. Upfront S-IVL usage occurred in 58% of cases; the rest were bail-out procedures due to suboptimal initial balloon predilation. S-IVL was used most commonly in the left anterior descending coronary artery (50%), with 1.3 ± 0.5 stents implanted/target vessel. Angiographic success (<20% residual stenosis) occurred in all cases, with no procedural complications.
S-IVL appears to be a useful modality in coronary calcium modification to optimize stent expansion. This device obviates the need for more complex lesion preparation strategies such as rotational atherectomy, except in severe undilatable cases where S-IVL is impossible. Further study is warranted to compare different calcium modification devices with conventional balloon angioplasty.
冠状动脉钙化病变常导致支架扩张不理想，这是支架血栓形成和再狭窄等不良后果的最大预测因素之一。冲击波血管内碎石术（S-IVL；Shockwave Medical公司）是一种最近获批用于治疗严重钙化冠状动脉病变的技术。我们介绍了我们使用S-IVL设备的早期真实世界经验。
纳入2018年10月至2019年1月在我们中心接受经皮冠状动脉介入治疗（PCI）期间接受S-IVL治疗的所有患者。
在此期间，共有26例接受PCI的患者在支架置入前接受了S-IVL治疗（男性占69%；年龄72±8岁）。PCI的适应证为14例患者（54%）的急性冠状动脉综合征（ACS）、11例患者（42%）的稳定型心绞痛和1例患者（4%）在经导管主动脉瓣植入术前的PCI。接受S-IVL进行PCI的ACS病例中，71%是在首次手术时针对被认为是ACS罪犯病变进行的，而29%是对严重非罪犯病变进行的分期PCI。58%的病例采用了早期S-IVL治疗；其余的是由于初始球囊预扩张不理想而进行的补救手术。S-IVL最常用于左前降支冠状动脉（50%），每个靶血管植入1.3±0.5个支架。所有病例均取得血管造影成功（残余狭窄<20%），无手术并发症。
S-IVL似乎是一种用于冠状动脉钙化改良以优化支架扩张的有用方法。除了在S-IVL无法进行的严重不可扩张病例外，该设备无需采用如旋磨术等更复杂的病变预处理策略。有必要进一步研究以比较不同的钙化改良设备与传统球囊血管成形术。
