Mastrangelo Angelo, Monizzi Giovanni, Galli Stefano, Grancini Luca, Ferrari Cristina, Olivares Paolo, Chiesa Mattia, Calligaris Giuseppe, Fabbiocchi Franco, Montorsi Piero, Bartorelli Antonio L
Department of Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Milan, Milan, Italy.
Bioinformatics and Artificial Intelligence Facility, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Milan, Milan, Italy.
Front Cardiovasc Med. 2022 Feb 21;9:829117. doi: 10.3389/fcvm.2022.829117. eCollection 2022.
This study aims to describe the outcome of intravascular lithotripsy (IVL) when used with different indications and to assess the short- and long-term outcomes of IVL-facilitated percutaneous coronary intervention (PCI).
Intravascular lithotripsy can improve the results of PCI of calcified coronary lesions with a low rate of periprocedural complications.
A total of 105 consecutive patients with 110 calcified lesions underwent IVL. A total of 87 lesions were treated by IVL with the following indications: 25 before attempting other balloon-based devices (primary IVL), 51 after the failure of non-compliant balloon dilatation (secondary IVL), and 11 after stent implantation because of stent under expansion (bailout IVL). In 23 lesions, IVL was used for the treatment of in-stent restenosis (ISR). Effectiveness (angiographic success) and safety [major adverse cardiovascular events (MACEs) and IVL-related procedural complications] endpoints were assessed.
Angiographic success was achieved in 84.6% of lesions. Early MACEs were periprocedural MI only, ranging from 6.7 to 20% depending on MI definition. The flow-limiting dissections rate was 2.7%. A total of five (4.5%) IVL balloons ruptured during treatment with subsequent vessel perforation in 1 case. MACEs at 12 months were 13.3%, with TLR occurring in 8 lesions (12% primary IVL, 0% secondary IVL, 0% bailout IVL, and 21.7% IVL for ISR, = 0.002).
Treatment of calcified coronary lesions with IVL in a "real-world" setting can be performed with high success, low rate of procedural complications, and an acceptable MACEs rate. Target lesion failure may be more frequent when IVL is performed for the treatment of ISR due to calcium-mediated stent under expansion.
本研究旨在描述血管内碎石术（IVL）在不同适应证下的治疗结果，并评估IVL辅助经皮冠状动脉介入治疗（PCI）的短期和长期疗效。
血管内碎石术可改善钙化冠状动脉病变PCI的效果，且围手术期并发症发生率较低。
连续105例患者共110处钙化病变接受了IVL治疗。87处病变按以下适应证接受IVL治疗：25处病变在尝试其他球囊扩张装置之前（初次IVL），51处病变在非顺应性球囊扩张失败后（二次IVL），11处病变在支架植入后因支架扩张不全（补救性IVL）。23处病变采用IVL治疗支架内再狭窄（ISR）。评估有效性（血管造影成功）和安全性[主要不良心血管事件（MACE）和IVL相关手术并发症]终点。
84.6%的病变实现了血管造影成功。早期MACE仅为围手术期心肌梗死，根据心肌梗死定义，发生率为6.7%至20%。血流限制性夹层发生率为2.7%。共有5个（4.5%）IVL球囊在治疗过程中破裂，其中1例随后发生血管穿孔。12个月时MACE发生率为13.3%，8处病变发生靶病变血运重建（TLR）（初次IVL为12%，二次IVL为0%，补救性IVL为0%，ISR的IVL为21.7%，P = 0.002）。
在“真实世界”环境中，用IVL治疗钙化冠状动脉病变成功率高、手术并发症发生率低且MACE发生率可接受。因钙介导的支架扩张不全而进行IVL治疗ISR时，靶病变失败可能更常见。
