eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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4/2021
vol. 17
 
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abstract:
Original paper

Efficacy and safety of shockwave intravascular lithotripsy (S-IVL) in calcified unprotected left main percutaneous coronary intervention – short-term outcomes

Piotr Rola
1
,
Adrian Włodarczak
2
,
Jan J. Kulczycki
2
,
Matuesz Barycki
1
,
Łukasz Furtan
1
,
Maciej Pęcherzewski
2
,
Marek Szudrowicz
2
,
Szymon Włodarczak
2
,
Adrian Doroszko
3
,
Maciej Lesiak
4

  1. Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
  2. Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
  3. Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
  4. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
Adv Interv Cardiol 2021; 17, 4 (66): 344–348
DOI: https://doi.org/10.5114/aic.2021.112524
Online publish date: 2021/12/30
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Introduction
Left main (LM) disease is associated with a large myocardial ischemic territory. Calcification with co-existing undilatable lesions is a predictor of poor clinical outcomes following LM percutaneous coronary interventions (PCI).

Aim
To evaluate the safety and efficiency of shockwave intravascular lithotripsy (S-IVL) in highly calcified LM diseases.

Material and methods
The study population consisted of sixteen patients qualified for PCI – mainly males (81.3%) with coronary artery disease (CAD) treated with left main S-IVL PCI due to unsuccessful attempts of plaque modification with a non-compliant (NC) balloon catheter, or rotational devices. Clinical success was defined as effective stent delivery and deployment (with less than < 20% in-stent residual stenosis) with preserved coronary flow TIMI-3 (Thrombolysis in Myocardial Infarction) at the end of the procedure.

Results
The most frequent indication for PCI was acute coronary syndrome (ACS) (62.5%). In these high-risk (average Syntax score 24) patients, clinical success of PCI was achieved in 100% of cases. In the short-term observation, we recorded two major adverse cardiac and cerebrovascular events (MACCE) including one fatal, acute stent thrombosis.

Conclusions
Our data suggest that the use of S-IVL is safe and effective as a bail-out strategy to manage LM lesions resistant to high-pressure NC balloon inflation. Despite encouraging initial results, future large studies with long-term observation are required to evaluate the safety and efficacy of S-IVL in LM stenosis.

keywords:

percutaneous coronary intervention, left main diseases, intravascular lithotripsy, calcification, coronary artery diseases
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