Haukeland University Hospital, Bergen, Norway.
St George's University Hospital, London, UK.
J Interv Cardiol. 2021 Jun 21;2021:9958035. doi: 10.1155/2021/9958035. eCollection 2021.
Intravascular lithotripsy (IVL) has been shown to be safe and effective for calcium modification in nonocclusive coronary artery disease (CAD), but there are only case reports of its use in calcified chronic total occlusions (CTO). We report data from an international multicenter registry of IVL use during CTO percutaneous coronary intervention (PCI) and provide provisional data regarding its efficacy and safety. During the study period, IVL was used in 55 of 1053 (5.2%) CTO PCI procedures. IVL was used within the occluded segment after successful CTO crossing in 53 procedures and during incomplete CTO crossing in 2 cases. The mean J-CTO score was 3.1. CTO PCI technical and procedural success was achieved in 53 (96%) and 51 (93%) cases. Six patients had a procedural complication, with 3 main vessel perforations (5%). Two had covered stent implantation, one required pericardiocentesis, and one was managed conservatively. All had combination therapy with another calcium modification device. Two patients had a procedural myocardial infarction (PMI) (4%), and two others had a major adverse cardiovascular event (MACE) (4%) at a median follow-up of 13 (4-21) months. IVL can effectively facilitate calcium modification during CTO PCI. More data are required to establish the efficacy and safety of IVL and other calcium modification devices when used extraplaque or in combination during CTO PCI.
血管内碎石术 (IVL) 已被证明在非闭塞性冠状动脉疾病 (CAD) 中的钙改性是安全有效的，但仅有关于其在钙化性慢性完全闭塞 (CTO) 中应用的病例报告。我们报告了一项关于 IVL 在 CTO 经皮冠状动脉介入治疗 (PCI) 中应用的国际多中心注册研究的数据，并提供了其疗效和安全性的临时数据。在研究期间，在 1053 例 CTO PCI 手术中，有 55 例（5.2%）使用了 IVL。在 53 例手术中，在成功穿过 CTO 后在闭塞段内使用了 IVL，在 2 例手术中在不完全穿过 CTO 时使用了 IVL。平均 J-CTO 评分为 3.1。53 例（96%）和 51 例（93%）患者实现了 CTO PCI 技术和程序上的成功。6 例患者发生了程序并发症，其中 3 例主血管穿孔（5%）。2 例需要植入覆盖支架，1 例需要心包穿刺，1 例保守治疗。所有患者均采用另一种钙改性装置进行联合治疗。2 例患者发生了程序心肌梗死 (PMI)（4%），2 例患者发生了重大不良心血管事件 (MACE)（4%），中位随访时间为 13 个月（4-21 个月）。IVL 可以有效地促进 CTO PCI 中的钙改性。需要更多的数据来确定 IVL 和其他钙改性装置在 CTO PCI 中额外斑块或联合使用时的疗效和安全性。
