Intravascular Lithotripsy for Calcium Modification in Chronic Total Occlusion Percutaneous Coronary Intervention.

Anja Øksnes,James C S Spratt,Colm Hanratty,Jack Laffan,Julian Strange,Sinjini Biswas,Aadil Shaukat,Margaret Mcentegart,Claudia Cosgrove,Kjetil Halvorsen Løland,Simon Walsh

doi:10.1155/2021/9958035

Abstract

Intravascular lithotripsy (IVL) has been shown to be safe and effective for calcium modification in nonocclusive coronary artery disease (CAD), but there are only case reports of its use in calcified chronic total occlusions (CTO). We report data from an international multicenter registry of IVL use during CTO percutaneous coronary intervention (PCI) and provide provisional data regarding its efficacy and safety. During the study period, IVL was used in 55 of 1053 (5.2%) CTO PCI procedures. IVL was used within the occluded segment after successful CTO crossing in 53 procedures and during incomplete CTO crossing in 2 cases. The mean J-CTO score was 3.1. CTO PCI technical and procedural success was achieved in 53 (96%) and 51 (93%) cases. Six patients had a procedural complication, with 3 main vessel perforations (5%). Two had covered stent implantation, one required pericardiocentesis, and one was managed conservatively. All had combination therapy with another calcium modification device. Two patients had a procedural myocardial infarction (PMI) (4%), and two others had a major adverse cardiovascular event (MACE) (4%) at a median follow-up of 13 (4–21) months. IVL can effectively facilitate calcium modification during CTO PCI. More data are required to establish the efficacy and safety of IVL and other calcium modification devices when used extraplaque or in combination during CTO PCI.

Highlights

Calcification within a chronic total occlusion (CTO) is an independent predictor of percutaneous coronary intervention (PCI) failure, prolonged procedure duration, suboptimal stent expansion, and complications and is a key characteristic in CTO complexity scores [1,2,3,4]
1053 patients had CTO PCI, with Intravascular lithotripsy (IVL) used for calcium modification within the occluded segment in 55 patients (5,2%)
Clinical presentation, and CTO characteristics are described in Table 1. e CTOs were high complexity with 36% having previous coronary artery bypass grafting (CABG), 20% having a previous failed CTO PCI attempt, and with a mean J-CTO score of 3.1

Summary

Introduction

Calcification within a chronic total occlusion (CTO) is an independent predictor of percutaneous coronary intervention (PCI) failure, prolonged procedure duration, suboptimal stent expansion, and complications and is a key characteristic in CTO complexity scores [1,2,3,4]. Calcium modification is frequently performed during CTO PCI using scoring (SB), cutting (CB), and highpressure (OPN) balloons or rotational (RA), orbital or laser atherectomy, there are limited published data on Journal of Interventional Cardiology the efficacy and safety of these devices in this patient population [6, 7]. TM Shockwave intravascular lithotripsy (IVL) balloon has been demonstrated to be safe and effective in nonocclusive CAD [8,9,10,11,12], there are only few case reports of its use during CTO PCI [13, 14]. We describe the initial experience of using IVL during CTO PCI and provide provisional data regarding its efficacy and safety

Materials and Methods

Results

Conclusion

Conflicts of Interest