Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA.
Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Cardiovasc Revasc Med. 2022 Oct;43:80-84. doi: 10.1016/j.carrev.2022.05.003. Epub 2022 May 7.
Intravascular lithotripsy (IVL) is a novel endovascular treatment for calcified common femoral artery disease (CFA). Data on midterm effectiveness for clinically driven target lesions revascularization (CD-TLR) is lacking. This study investigated CD-TLR during 18-month follow-up in patients requiring IVL for CFA disease treatment.
In a single-center retrospective cohort study, electronic medical record of patients undergoing IVL for CFA disease from January 2018 to March 2020 were reviewed. Primary outcome was CD-TLR estimated by Kaplan-Meier method during 18-month follow-up. Univariate logistic regression was used to compare differences in CD-TLR by the type of adjunct therapy used.
Among 54 CFA lesions in 50 patients, mean age (SD) was 75(8) years, gender and race were predominantly male (74%, n = 37) and white (94%, n = 47), respectively. Rutherford class III claudication was most common (70%, n = 35) with mean ABI of 0.66 (0.26) and mean angiographic stenosis of 77% (13%). Adjunct use of drug-coated balloon (DCB) angioplasty was 83% (n = 45) and atherectomy was 39% (n = 21). Residual angiographic stenosis was <30% in all cases. Complications included dissection requiring stent placement (2%, n = 1). After 18-months, 18% (n = 9) died unrelated to procedural complications and 6% (n = 3) were lost to follow-up. 18-month cumulative freedom from CD-TLR was 80.6% (95% CI: 69.1%, 92%). Univariate logistic regression did not reveal a statistically significant difference in CD-TLR with type of adjunct therapy used (p > 0.05).
IVL with adjunct use of DCB and/or atherectomy is safe and effective in treatment of calcified CFA disease. Randomized studies are required to confirm these findings.
血管内碎石术（IVL）是一种治疗钙化性股总动脉疾病（CFA）的新型血管内治疗方法。对于临床驱动的靶病变血运重建（CD-TLR）的中期有效性数据尚缺乏。本研究调查了 50 例患者的 54 个 CFA 病变，在 18 个月的随访期间，接受 IVL 治疗 CFA 疾病的患者的 CD-TLR。主要终点是通过 Kaplan-Meier 方法在 18 个月的随访期间估计 CD-TLR。使用单变量逻辑回归比较了使用不同辅助治疗方法的 CD-TLR 差异。
在 50 例患者的 54 个 CFA 病变中，平均年龄（标准差）为 75（8）岁，性别和种族主要为男性（74%，n=37）和白人（94%，n=47）。最常见的是 Rutherford Ⅲ级跛行（70%，n=35），平均踝肱指数为 0.66（0.26），平均血管造影狭窄率为 77%（13%）。药物涂层球囊（DCB）血管成形术的辅助使用率为 83%（n=45），旋切术为 39%（n=21）。所有病例的残余血管造影狭窄均<30%。并发症包括需要支架置入的夹层（2%，n=1）。在 18 个月时，18%（n=9）与程序并发症无关的死亡，6%（n=3）失访。18 个月时 CD-TLR 的累积无复发生存率为 80.6%（95%CI：69.1%，92%）。单变量逻辑回归未显示使用辅助治疗方法与 CD-TLR 之间存在统计学显著差异（p>0.05）。
使用 DCB 和/或旋切术辅助 IVL 治疗钙化性 CFA 疾病是安全有效的。需要随机研究来证实这些发现。
