Oliveri Federico, Van Oort Martijn J H, Al Amri Ibtihal, Bingen Brian O, Claessen Bimmer E, Dimitriu-Leen Aukelien C, Kefer Joelle, Girgis Hany, Vossenberg Tessel, Van der Kley Frank, Jukema J Wouter, Montero-Cabezas Josè M
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(5):102635. doi: 10.1016/j.jscai.2025.102635. eCollection 2025 May.
Intravascular lithotripsy IVL) has been demonstrated to be effective in treating balloon-crossable calcified coronary lesions by inducing calcium fractures and facilitating stent expansion (SE), theoretically by improving coronary artery compliance (CACom). Direct evidence of this theory has not yet been provided.
From the BENELUX-IVL prospective registry (NCT06577038) enrolling patients with calcified coronary artery lesions treated with IVL, intravascular ultrasound-guided cases were selected. CACom was calculated as the systo-diastolic change in the luminal area (ΔA), measured using intravascular ultrasound, relative to the corresponding change in aortic pressure (ΔP). Measurements were taken directly before (pre-CACom) and after (post-CACom) IVL therapy at the most calcified segment, where IVL pulses were administered. The primary end point was CACom modification (ΔCACom), defined as post-CACom - pre-CACom, with a correlation analysis between ΔCACom and new fractures as a key exploratory aim. Secondary analysis included assessing whether ΔCACom could predict SE at the minimum stent area (MSA) and the eccentricity index.
Coronary artery compliance significantly improved after IVL therapy (median ΔCACom 0.33 [0.19-0.70] mm/mm Hg; < .01). Lesions showing new calcium fractures presented significantly greater ΔCACom compared to those without. ΔCACom and new calcium fractures were significantly correlated (R = 0.466; < .01). In univariate analysis, ΔCACom was found to be a significant predictor for SE at MSA ( < .01), MSA ( = .015), and SE >80% ( = .025), but not eccentricity index ( = .157). At multivariate analysis, ΔCACom was an independent predictor of SE (R = 0.420; = .044) and SE >80% at MSA (OR, 6.58 [1.24-34.90]; = .043).
In heavily calcified coronary lesions treated with IVL, ΔCACom is an independent predictor of SE.
血管内碎石术（IVL）已被证明可有效治疗球囊可通过的钙化冠状动脉病变，其通过诱导钙骨折并促进支架扩张（SE），理论上是通过改善冠状动脉顺应性（CACom）来实现的。该理论的直接证据尚未得到证实。
从比荷卢经济联盟-IVL前瞻性注册研究（NCT06577038）中选取接受IVL治疗的钙化冠状动脉病变患者的血管内超声引导病例。CACom通过血管内超声测量的管腔面积的收缩-舒张变化（ΔA）相对于主动脉压力的相应变化（ΔP）来计算。在给予IVL脉冲的最钙化节段，在IVL治疗前（CACom前）和治疗后（CACom后）直接进行测量。主要终点是CACom改变（ΔCACom），定义为CACom后 - CACom前，以ΔCACom与新骨折之间的相关性分析作为关键探索性目标。次要分析包括评估ΔCACom是否可以预测最小支架面积（MSA）处的SE和偏心指数。
IVL治疗后冠状动脉顺应性显著改善（中位ΔCACom 0.33 [0.19 - 0.70] mm/mm Hg；P <.01）。与没有新钙骨折的病变相比，出现新钙骨折的病变表现出显著更大的ΔCACom。ΔCACom与新钙骨折显著相关（R = 0.466；P <.01）。在单变量分析中，发现ΔCACom是MSA处SE（P <.01）、MSA（P =.015）和SE > 80%（P =.025）的显著预测因子，但不是偏心指数（P =.157）的预测因子。在多变量分析中，ΔCACom是SE（R = 0.420；P =.044）和MSA处SE > 80%（OR，6.58 [1.24 - 34.90]；P =.043）的独立预测因子。
在接受IVL治疗的重度钙化冠状动脉病变中，ΔCACom是SE的独立预测因子。
