McInerney Angela, Travieso Alejandro, Jerónimo Baza Adrián, Alfonso Fernando, Del Val David, Cerrato Enrico, Garcia de Lara Juan, Pinar Eduardo, Perez de Prado Armando, Jimenez Quevedo Pilar, Tirado-Conte Gabriela, Nombela-Franco Luis, Brugaletta Salvatore, Cepas-Guillén Pedro, Sabaté Manel, Cubero Gallego Héctor, Vaquerizo Beatriz, Jurado Alfonso, Varbella Ferdinando, Jimenez Marcelo, Garcia Escobar Artemio, de la Torre José Maria, Amat Santos Ignacio, Jimenez Diaz Victor Alfonso, Escaned Javier, Gonzalo Nieves
Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain.
Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBER-CV, Madrid, Spain.
EuroIntervention. 2024 May 20;20(10):e656-e668. doi: 10.4244/EIJ-D-23-00605.
Coronary calcification negatively impacts optimal stenting. Intravascular lithotripsy (IVL) is a new calcium modification technique.
We aimed to assess the impact of different calcium morphologies on IVL efficacy.
This was a prospective, multicentre study (13 tertiary referral centres). Optical coherence tomography (OCT) was performed before and after IVL, and after stenting. OCT-defined calcium morphologies were concentric (mean calcium arc >180°) and eccentric (mean calcium arc ≤180°). The primary outcomes were angiographic success (residual stenosis <20%) and the presence of fracture by OCT in concentric versus eccentric lesions.
Ninety patients were included with a total of 95 lesions: 47 concentric and 48 eccentric. The median number of pulses was 60 (p=1.00). Following IVL, the presence of fracture was not statistically different between groups (79.0% vs 66.0% for concentric vs eccentric; p=0.165). The number of fractures/lesion (4.2±4.4 vs 2.3±2.8; p=0.018) and ≥3 fractures/lesion (57.1% vs 34.0%; p=0.029) were more common in concentric lesions. Angiographic success was numerically but not statistically higher in the concentric group (87.0% vs 76.6%; p=0.196). By OCT, no differences were noted in final minimum lumen area (5.9±2.2 mm vs 6.2±2.1 mm; p=0.570), minimum stent area (5.9±2.2 mm² vs 6.25±2.4 mm; p=0.483), minimum stent expansion (80.9±16.7% vs 78.2±19.8%), or stent expansion at the maximum calcium site (100.6±24.2% vs 95.8±27.3%) (p>0.05 for all comparisons of concentric vs eccentric, respectively). Calcified nodules were found in 29.5% of lesions; these were predominantly non-eruptive (57%). At the nodule site, dissection was more common than fracture with stent expansion of 103.6±27.2%.
In this prospective, multicentre study, the effectiveness of IVL followed by stenting was not significantly affected by coronary calcium morphology.
冠状动脉钙化对最佳支架置入产生负面影响。血管内碎石术（IVL）是一种新的钙修饰技术。
我们旨在评估不同钙形态对IVL疗效的影响。
这是一项前瞻性、多中心研究（13个三级转诊中心）。在IVL前后以及支架置入后进行光学相干断层扫描（OCT）。OCT定义的钙形态为同心（平均钙弧>180°）和偏心（平均钙弧≤180°）。主要结局为血管造影成功（残余狭窄<20%）以及同心病变与偏心病变中OCT显示的骨折情况。
纳入90例患者，共95个病变：47个同心病变和48个偏心病变。脉冲中位数为60（p = 1.00）。IVL后，两组间骨折情况无统计学差异（同心病变与偏心病变分别为79.0%对66.0%；p = 0.165）。骨折/病变数量（4.2±4.4对2.3±2.8；p = 0.018）以及≥3处骨折/病变（57.1%对34.0%；p = 0.029）在同心病变中更常见。同心组血管造影成功在数值上更高，但无统计学差异（87.0%对76.6%；p = 0.196）。通过OCT观察，最终最小管腔面积（5.9±2.2 mm对6.2±2.1 mm；p = 0.570）、最小支架面积（5.9±2.2 mm²对6.25±2.4 mm；p = 0.483）、最小支架扩张（80.9±16.7%对78.2±19.8%）或最大钙部位的支架扩张（100.6±24.2%对95.8±27.3%）均无差异（同心与偏心的所有比较p>0.05）。29.5%的病变中发现钙化结节；这些主要为非破裂型（57%）。在结节部位，夹层比骨折更常见，支架扩张率为103.6±27.2%。
在这项前瞻性、多中心研究中，IVL后行支架置入的有效性未受到冠状动脉钙形态的显著影响。
