Riley Robert F, Miller Larry E, Davies Rhian, Alaswad Khaldoon, Al-Jebaje Zaid, Doshi Darshan, Jaffer Farouc A, Adusumalli Srikanth, Frizzell Jarrod D, Kumar Kris, Patel Mitul P, Dakroub Ali, Ali Ziad A
Overlake Medical Center and Clinics, Bellevue, Washington.
Miller Scientific, Johnson City, Tennessee.
J Soc Cardiovasc Angiogr Interv. 2023 Nov 10;3(2):101213. doi: 10.1016/j.jscai.2023.101213. eCollection 2024 Feb.
Intravascular lithotripsy (IVL) safely and effectively modifies calcified coronary lesions during percutaneous coronary interventions (PCI). Data regarding its utility in modifying calcified left main coronary artery (LMCA) disease are limited. This study aimed to evaluate short-term outcomes of IVL-assisted LMCA PCI.
This retrospective multicenter all-comers study analyzed patients who underwent intravascular imaging-guided, IVL-assisted PCI for calcified LMCA disease. Clinical and procedural characteristics were obtained, including intravascular imaging measurements. Technical success was defined as successful stent deployment with <30% residual diameter stenosis. Major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, and target vessel revascularization evaluated immediately postprocedure and at 30-day follow-up.
Among 184 patients treated at 7 centers from 2019-2023, IVL-assisted LMCA PCI achieved 99.4% technical success. Calcium fracture was identified in 136/165 cases (82.4%) on post-IVL imaging. Pretreatment minimal luminal area increased significantly compared to post-PCI minimal stent area (MSA) (4.1 ± 1.3 to 9.3 ± 2.5 mm, respectively; < .001). There was a direct correlation between IVL balloon size and the final MSA ( = .002). In-hospital MACE was 4.4% and 30-day MACE was 8.8%. In multivariate logistic regression, presentation with troponin-positive myocardial infarction was the sole predictor of 30-day MACE.
IVL-assisted PCI for calcified LMCA lesions was safe and resulted in high technical success rates, confirming its utility as an effective treatment in this challenging lesion subset.
血管内碎石术（IVL）在经皮冠状动脉介入治疗（PCI）期间能安全有效地改善钙化冠状动脉病变。关于其在改善钙化左主干冠状动脉（LMCA）疾病中的效用的数据有限。本研究旨在评估IVL辅助的LMCA PCI的短期结局。
这项回顾性多中心纳入所有患者的研究分析了接受血管内成像引导的、IVL辅助的PCI治疗钙化LMCA疾病的患者。获取了临床和手术特征，包括血管内成像测量。技术成功定义为成功植入支架且残余直径狭窄<30%。主要不良心脏事件（MACE）是全因死亡、心肌梗死和靶血管血运重建的复合事件，在术后即刻和30天随访时进行评估。
在2019年至2023年期间于7个中心治疗的184例患者中，IVL辅助的LMCA PCI技术成功率达到99.4%。IVL术后成像在136/165例（82.4%）中发现了钙裂。与PCI术后最小支架面积（MSA）相比，预处理时的最小管腔面积显著增加（分别为4.1±1.3至9.3±2.5 mm；P<.001）。IVL球囊大小与最终MSA之间存在直接相关性（r = 0.002）。住院期间MACE为4.4%，30天MACE为8.8%。在多因素逻辑回归中，肌钙蛋白阳性心肌梗死是30天MACE的唯一预测因素。
IVL辅助的PCI治疗钙化LMCA病变是安全的，并导致了较高的技术成功率，证实了其作为这种具有挑战性病变亚组的有效治疗方法的效用。
