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

Lookup NU author(s): Muhammad Rashid, Dr Javed Ahmed

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Abstract

© 2023Background: 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.

Publication metadata

Author(s): Hesse K, Shahid F, Ahmed R, Ahmed F, Cartlidge TRG, Rashid M, Mamas MA, Mintz GS, Ahmed JM

Publication type: Article

Publication status: Published

Journal: Cardiovascular Revascularization Medicine

Year: 2023

Volume: 55

Pages: 33-41

Print publication date: 01/10/2023

Online publication date: 26/04/2023

Acceptance date: 21/04/2023

ISSN (print): 1553-8389

ISSN (electronic): 1878-0938

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.carrev.2023.04.019

DOI: 10.1016/j.carrev.2023.04.019

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