St. Francis Hospital, Roslyn, NY (Z.A.A., A.M., D.S., R.A.S.).
Cardiovascular Research Foundation, New York, NY (Z.A.A., A.M., M.M., R.A.S.).
Circ Cardiovasc Interv. 2023 Oct;16(10):e012898. doi: 10.1161/CIRCINTERVENTIONS.123.012898. Epub 2023 Oct 17.
Coronary intravascular lithotripsy (IVL) safely facilitates successful stent implantation in severely calcified lesions. This analysis sought to determine the relative impact of lesion calcium eccentricity on the safety and effectiveness of IVL using high-resolution optical coherence tomography imaging.
Individual patient-level data (n=262) were pooled from 4 distinct international prospective studies (Disrupt CAD I, II, III, and IV) and analyzed by an independent optical coherence tomography core laboratory. IVL performance in eccentric versus concentric calcification was analyzed by dividing calcified lesions into quartiles (≤180° [most eccentric], 181°-270°, 271°-359°, and 360° [concentric]) by maximum continuous calcium arc.
In the 230 patients with clear imaging field on optical coherence tomography, there were no differences in preprocedure minimum lumen area, diameter stenosis, or maximum calcium thickness. The calcium length and volume index increased progressively with increasing mean and maximum continuous calcium arc (ie, concentricity). Conversely, the minimum calcium thickness decreased progressively with increasing concentricity. Post-procedure, the number of calcium fractures, fracture depth, and fracture width increased with increasing concentricity, with a 4-fold increase in the number of fractures in lesions with 360° of calcium arc compared with ≤180°. This increase in IVL-induced calcium fracture with increasing calcium burden and concentricity facilitated stent expansion and luminal gain such that there were no significant differences across quartiles.
IVL induced calcium fractures proportional to the magnitude of coronary artery calcium, including in eccentric calcium, leading to consistent improvements in stent expansion and luminal gain in both eccentric and concentric calcified coronary lesions.
冠状动脉血管内碎石术（IVL）可安全地促进严重钙化病变中支架的成功植入。本分析旨在使用高分辨率光学相干断层扫描成像来确定病变钙偏心对 IVL 的安全性和有效性的相对影响。
将来自 4 项不同国际前瞻性研究（Disrupt CAD I、II、III 和 IV）的个体患者水平数据（n=262）汇总，并由独立的光学相干断层扫描核心实验室进行分析。通过最大连续钙弧将钙化病变分为 4 个四分位数（≤180°[最偏心]、181°-270°、271°-359°和 360°[同心]），分析偏心与同心钙化中 IVL 的性能。
在光学相干断层扫描有清晰成像视野的 230 名患者中，术前最小管腔面积、直径狭窄率或最大钙厚度无差异。钙长度和体积指数随平均和最大连续钙弧（即同心性）的增加而逐渐增加。相反，最小钙厚度随同心性的增加而逐渐降低。术后，钙断裂的数量、断裂深度和断裂宽度随同心性的增加而增加，与≤180°的病变相比，360°钙弧病变的骨折数量增加了 4 倍。随着钙负荷和同心性的增加，IVL 引起的钙断裂增加，从而促进支架扩张和管腔获得，因此在四分位数之间没有显著差异。
IVL 诱导的钙断裂与冠状动脉钙的大小成正比，包括偏心钙，从而导致偏心和同心钙化冠状动脉病变中支架扩张和管腔获得的一致改善。
