Division of Cardiology, Western Kentucky Heart and Lung and Med Center Health, Bowling Green, KY, United States of America; Department of Medicine, University of Kentucky at Bowling Green, Bowling Green, KY, United States of America.
Division of Cardiology, Alpert Medical School of Brown University, Providence, RI, United States of America.
Cardiovasc Revasc Med. 2022 Jul;40:37-41. doi: 10.1016/j.carrev.2021.11.029. Epub 2021 Nov 27.
Intravascular lithotripsy (IVL) is a novel tool for the treatment of calcified vascular stenosis. Recently, IVL has been successfully used for modification of calcified plaque in coronary and lower extremity peripheral arteries with promising results. However, experience in subclavian and innominate peripheral arterial disease is limited. This study aims to report our initial experience of IVL use in calcified subclavian and innominate vasculature.
This was a retrospective review of all the cases of IVL performed in subclavian and innominate arteries at the Miriam Hospital, Providence, between January 2019 and May 2020. Data on the baseline and procedural characteristics were collected. The primary endpoint was procedural success defined as residual stenosis of <20% after stenting. Other endpoints of interest were; 1) procedural complications, including dissections, perforations, abrupt closure, slow or no-reflow, thrombosis, and distal embolization; 2) in-hospital major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, or stroke/transient ischemic attack.
A total of 7 patients with 13 lesions undergoing IVL were included. Of these, 5 (71%) were women, the mean age was 74.6 ± 12.9, and the mean BMI was 25.1 ± 6.7. IVL was successfully delivered to all the target lesions with a mean 252.9 ± 54.4 pulses delivered per patient. Procedural success was achieved in 100% of the treated lesions. No procedure-related complications or in-hospital MACE occurred in any of the patients.
In this single-center retrospective analysis, IVL facilitated acute procedural success without any procedural complications in severely calcified stenoses of the subclavian and innominate vasculature. Larger studies with an active comparator and longer follow-up are needed to establish the relative efficacy and safety of IVL use in this vascular bed.
血管内碎石术（IVL）是一种治疗钙化性血管狭窄的新型工具。最近，IVL 已成功用于治疗冠状动脉和下肢外周动脉的钙化斑块，取得了良好的效果。然而，在锁骨下和无名外周动脉疾病方面的经验有限。本研究旨在报告我们在钙化性锁骨下和无名血管中使用 IVL 的初步经验。
这是对 2019 年 1 月至 2020 年 5 月期间在普罗维登斯米里亚姆医院接受锁骨下和无名动脉 IVL 治疗的所有病例进行的回顾性研究。收集了基线和程序特征的数据。主要终点是残余狭窄<20%的支架置入后定义为手术成功。其他感兴趣的终点包括：1）手术并发症，包括夹层、穿孔、急性闭塞、缓慢或无再流、血栓形成和远端栓塞；2）院内主要不良心脏事件（MACE）定义为死亡、心肌梗死或卒中/短暂性脑缺血发作的复合事件。
共纳入 7 例 13 处病变行 IVL 治疗的患者。其中，女性 5 例（71%），平均年龄 74.6±12.9 岁，平均 BMI 为 25.1±6.7。所有目标病变均成功输送 IVL，每位患者平均输送 252.9±54.4 个脉冲。100%的治疗病变均达到手术成功。所有患者均未发生与手术相关的并发症或院内 MACE。
在这项单中心回顾性分析中，IVL 在严重钙化性锁骨下和无名血管狭窄病变中，无需任何手术并发症即可实现急性手术成功。需要更大规模的、有活性对照和更长随访时间的研究来确定 IVL 在该血管床应用的相对疗效和安全性。
