Abstract 18968: Safety and Efficacy of Shockwave Intravascular Lithotripsy in the Management of Calcified Coronary Arteries: A Systematic Review and Meta-Analysis

Abstract

Introduction: Shockwave intravascular lithotripsy (SWL) aims to facilitate optimal stent delivery and expansion for improved blood flow in treating calcified coronary artery disease. We sought to assess the safety and efficacy of SWL in managing de novo calcified lesions, lesions after failed/sub-optimal pre-dilatation with conventional balloon-based devices, under-expanded stents, and in-stent restenosis. Methods: A comprehensive literature search (Medline, Embase, Web of Science, Cochrane, and Google Scholar) was performed for studies that evaluated SWL in managing calcified coronary lesions. Efficacy outcomes included residual stenosis <30% and successful stent delivery with a low incidence of device delivery failure. Safety outcomes included procedural complications and major adverse cardiovascular events (MACE). MACE is a composite outcome of all-cause mortality, cardiac mortality, myocardial infarction, target vessel/lesion revascularization, and stent thrombosis. Event rates across the included studies were pooled in a meta-analysis using the random effects model. An overall estimate and 95% confidence interval were reported for each outcome. Heterogeneity was estimated using the I-squared statistic. Results: Out of the 1446 identified studies, 40 were included, with a total of 2718 patients. Residual stenosis <30% was achieved in 91.3% of patients (95% confidence interval 89.7% to 92.6%). Device delivery failure occurred in 6.7% of patients (95% CI 5% to 9%). In-hospital MACE occurred in 6.1% of patients (95% CI 5% to 7.4%), 30-day MACE in 7.4% (95% CI 6.2% to 8.8%), 6-month MACE in 8.3% (95% CI 7.1% to 9.6%), and 1-year MACE in 10% (95% CI 8.7% to 11.4%). Conclusions: SWL is a safe and efficient calcium modification intervention with high clinical success, minimal angiographic complications, and a low adverse event rate. Direct comparisons with the standard of care are needed in larger studies to establish clinical utility and superiority.