35 Intravascular lithotripsy-assisted PCI for severe calcific coronary disease: evaluating the impact on quality of life and outcomes

Abstract

<h3>Introduction</h3> Severe coronary artery calcification (CAC) in patients undergoing percutaneous coronary intervention (PCI) is a common cause of procedural complications, lack of success, and stent failure. In this study we examine the utility of a novel technique to deal with this problem: intravascular lithotripsy (IVL) using the ‘Shockwave’ device. <h3>Methods</h3> A retrospective single centre study was conducted of consecutive patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Procedural success was verified by independent review of the angiogram and defined as (1) adequate stent expansion, (2) no significant residual stenosis and (3) TIMI III flow in all major branches. Target lesion revascularisation (TLR) was defined as any unplanned repeat PCI of the target lesion or bypass of the target vessel performed for in-stent restenosis (ISR) or other complication of the target lesion. Clinical outcomes including Canadian Cardiovascular Society (CCS) angina classification were assessed at virtual clinical follow-up. <h3>Results</h3> 47 patients were treated with IVL during the study period. Baseline demographics and procedural characteristics are seen in tables 1 and 2, respectively. All patients had circumferential or near-circumferential calcium as determined by coronary angiography ± intracoronary imaging. 57% had treatment of a de novo lesion, 32% had PCI to a previously placed under-expanded stent and 11% had severely calcified ISR. Procedural success was high (94%), however, reasons for failure/abandonment included: (i) intra-procedural ischaemia with significant residual stenosis, (ii) prolonged procedural time, ischaemia and resistant stent under-expansion and (iii) prolonged procedural time, dissection with no-reflow, in the setting of a chronic total occlusion (CTO). <h3>Complications Included</h3> Coronary dissection (13%) of which the majority were successfully treated with conservative measures and coronary perforation (2%) which was treated with prolonged balloon inflation. At a mean follow up of 10 months, 23% underwent planned/staged-PCI, 4% underwent CABG and there were 2 (4%) deaths. There was a 51% reduction in CCS angina class from 2.9 (prior to IVL) to 1.4 (post IVL), p&lt;0.00001. <h3>Conclusions</h3> The use of coronary IVL is a very effective percutaneous therapy for severe CAC. This cohort shows high procedural success with IVL and a significant reduction in CCS angina class at follow-up.