Finnegan Paula, Jefferies John, Margey Ronan, Hennigan Barry
Resident Medical Officer, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland.
Consultant Interventional Cardiologist, and Senior Clinical Lecturer, University College Cork, The Mater Private Hospital, Citygate, Mahon, Cork, Republic of Ireland.
Br J Cardiol. 2020 Jul 28;27(2):21. doi: 10.5837/bjc.2020.021. eCollection 2020.
Coronary lithotripsy is a novel approach to percutaneous coronary intervention (PCI). It is based on well-established technology dating back to 1980 when lithotripsy was first used to treat renal calculi. Its application in cardiovascular medicine is a more recent development that involves using a low-pressure lithotripsy balloon to deliver unfocused acoustic pulse waves in a circumferential mechanical energy distribution. This causes fracturing of calcification within the surrounding vasculature, facilitating optimal stent deployment. This article aims to review recent clinical experience and the published data regarding intravascular lithotripsy (IVL). All relevant articles were identified via PubMed using keywords including "intravascular lithotripsy", "shockwave" and "coronary". All studies that contained published datasets regarding IVL with patient numbers >50 were included for review. There were 116 results found. After reviewing all the publications, articles were then tabulated and 17 were found to be relevant, including only four clinical studies. In this review we found that intracoronary lithotripsy for heavily calcified arteries appears to be a safe, effective, easy-to-use method of dealing with an otherwise technically-challenging and high-risk scenario. It appears to carry low risk, uses low pressures, and exerts its effects on both superficial and deep intravascular calcium. Further prospective data with long-term follow-up will be required to explore both the off-label uses of IVL (such as post-stent dilatation), and the long-term patency of these vessels.
冠状动脉碎石术是经皮冠状动脉介入治疗（PCI）的一种新方法。它基于一项成熟的技术，可追溯到1980年，当时首次使用碎石术治疗肾结石。其在心血管医学中的应用是一项较新的进展，涉及使用低压碎石球囊以圆周机械能分布的方式传递非聚焦声脉冲波。这会导致周围脉管系统内的钙化破裂，有助于优化支架置入。本文旨在综述关于血管内碎石术（IVL）的近期临床经验和已发表的数据。通过PubMed使用包括“血管内碎石术”、“冲击波”和“冠状动脉”等关键词识别所有相关文章。纳入所有包含患者数量>50的关于IVL的已发表数据集的研究进行综述。共找到116个结果。在查阅所有出版物后，将文章制成表格，发现17篇相关，其中只有4项临床研究。在本综述中，我们发现对于严重钙化的动脉，冠状动脉内碎石术似乎是一种安全、有效、易于使用的方法，可应对原本技术上具有挑战性且高风险的情况。它似乎风险较低，使用低压，并且对浅表和深部血管内钙化均有作用。需要进一步的长期随访前瞻性数据来探索IVL的非标签用途（如支架置入后扩张）以及这些血管的长期通畅情况。
