Early experience of intravascular lithotripsy in unprotected calcified left main coronary artery disease

Hesse, Kerrick; Shahid, Farhan; Ahmed, Raheel; Ahmed, Faizan; Cartlidge, Timothy R.G.; Rashid, Muhammad; Mamas, Mamas A.; Mintz, Gary S.; Ahmed, Javed M.

Abstract

Background
Treatment of unprotected severely calcified left main coronary artery (LMCA) disease is a complex interventional procedure. Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are safe and effective methods of treating coronary calcification in the non-LMCA setting. This retrospective analysis assessed the feasibility of IVL versus RA in unprotected LMCA disease.

Methods
We analyzed IVL and RA procedures performed at a large tertiary hospital in the Northeast of England from January 1, 2019 to April 31, 2022. Major safety and efficacy endpoints were procedural and angiographic success, defined by stent delivery with <50 % residual stenosis and without clinical or angiographic complications, respectively. Another important clinical endpoint was the composite of major adverse cardiac events (MACE) at 1 year.

Results
From 242 patients, 44 had LMCA IVL, 81 had LMCA RA and 117 had non-LMCA IVL. Patients with LMCA disease were older and more likely to have aortic stenosis. IVL was a second-line or bailout technique in 86.4 % LMCA and 92.2 % non-LMCA cases. Procedural and angiographic success rates were ≥ 84 % across all groups (p > 0.05). In 3 LMCA IVL and 3 LMCA RA cases arrhythmias and cardiac tamponade complicated the procedures respectively. At 1 year, MACE occurred in 10/44 (22.7 %) LMCA IVL, 16/81 (19.8 %) LMCA RA and 25/117 (21.4 %) cases (p > 0.05).

Conclusion
In our single center retrospective analysis, IVL is feasible in unprotected calcified LMCA as a second-line and third-line adjuvant calcium modification technique. Its use in unprotected calcified LMCA disease should be formalized with the undertaking of large randomized controlled trials.

Citation

Hesse, K., Shahid, F., Ahmed, R., Ahmed, F., Cartlidge, T. R., Rashid, M., …Ahmed, J. M. (2023). Early experience of intravascular lithotripsy in unprotected calcified left main coronary artery disease. Cardiovascular Revascularization Medicine, 55, 33-41. https://doi.org/10.1016/j.carrev.2023.04.019

• Journal Article Type: Article
• Acceptance Date: Apr 21, 2023
• Online Publication Date: Apr 26, 2023
• Publication Date: 2023-10
• Deposit Date: Feb 9, 2024
• Journal: Cardiovascular Revascularization Medicine
• Print ISSN: 1553-8389
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Pages: 33-41
• DOI: https://doi.org/10.1016/j.carrev.2023.04.019
• Keywords: Cardiology and Cardiovascular Medicine; General Medicine
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1553838923001604?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Early experience of intravascular lithotripsy in unprotected calcified left main coronary artery disease; Journal Title: Cardiovascular Revascularization Medicine; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.carrev.2023.04.019; Content Type: article; Copyright: © 2023 Elsevier Inc. All rights reserved.