Intravascular Lithotripsy for the Treatment of Calcium-Mediated Coronary In-Stent Restenoses

TY - JOUR

T1 - Intravascular Lithotripsy for the Treatment of Calcium-Mediated Coronary In-Stent Restenoses

AU - Brunner, Fabian J

AU - Becher, Peter Moritz

AU - Waldeyer, Christoph

AU - Zengin-Sahm, Elvin

AU - Schnabel, Renate B

AU - Clemmensen, Peter

AU - Westermann, Dirk

AU - Blankenberg, Stefan

AU - Seiffert, Moritz

PY - 2021/1

Y1 - 2021/1

N2 - BACKGROUND: Coronary intravascular lithotripsy (IVL) has recently been evaluated for the treatment of severely calcified native coronary lesions. Evidence for its use in in-stent restenosis is sparse and is still an off-label indication. Therefore, we aimed to evaluate the feasibility, safety, and acute and mid-term angiographic outcomes after IVL for the treatment of calcium-mediated coronary in-stent restenosis.METHODS: A retrospective, single-center analysis was performed for 6 cases with undilatable instent restenosis due to calcium-mediated stent underexpansion and/ or calcified neointima from January to November 2019. Lesions were treated with IVL (Shockwave Medical) and subsequent drug-eluting stent or drug-coated balloon. Angiographic success was defined as residual lumen stenosis <20% and Thrombolysis in Myocardial Infarction 3 flow. Follow-up angiography was performed at a median of 141.5 days.RESULTS: Six patients presented with symptomatic in-stent restenoses (65.8% to 87.9%) at 11 to 175 months after implantation. Intravascular and angiographic imaging detected calcium-mediated stent underexpansion (n = 2), calcified neointima (n = 2), or a combination of both (n = 2) as cause of restenosis. In-stent IVL, subsequent high-pressure balloon dilation, and drug-eluting stent or drug-coated balloon implantation were performed successfully in all cases. Acute angiographic success and angina relief were achieved in 5 of 6 cases and sustained during follow-up. No major acute cardiovascular events occurred.CONCLUSIONS: The application of IVL for the treatment of calcium-mediated coronary in-stent restenosis was feasible and safe, and yielded promising short- and mid-term results in the majority of cases.

AB - BACKGROUND: Coronary intravascular lithotripsy (IVL) has recently been evaluated for the treatment of severely calcified native coronary lesions. Evidence for its use in in-stent restenosis is sparse and is still an off-label indication. Therefore, we aimed to evaluate the feasibility, safety, and acute and mid-term angiographic outcomes after IVL for the treatment of calcium-mediated coronary in-stent restenosis.METHODS: A retrospective, single-center analysis was performed for 6 cases with undilatable instent restenosis due to calcium-mediated stent underexpansion and/ or calcified neointima from January to November 2019. Lesions were treated with IVL (Shockwave Medical) and subsequent drug-eluting stent or drug-coated balloon. Angiographic success was defined as residual lumen stenosis <20% and Thrombolysis in Myocardial Infarction 3 flow. Follow-up angiography was performed at a median of 141.5 days.RESULTS: Six patients presented with symptomatic in-stent restenoses (65.8% to 87.9%) at 11 to 175 months after implantation. Intravascular and angiographic imaging detected calcium-mediated stent underexpansion (n = 2), calcified neointima (n = 2), or a combination of both (n = 2) as cause of restenosis. In-stent IVL, subsequent high-pressure balloon dilation, and drug-eluting stent or drug-coated balloon implantation were performed successfully in all cases. Acute angiographic success and angina relief were achieved in 5 of 6 cases and sustained during follow-up. No major acute cardiovascular events occurred.CONCLUSIONS: The application of IVL for the treatment of calcium-mediated coronary in-stent restenosis was feasible and safe, and yielded promising short- and mid-term results in the majority of cases.

KW - Calcium

KW - Coronary Angiography

KW - Coronary Restenosis/diagnosis

KW - Drug-Eluting Stents/adverse effects

KW - Humans

KW - Lithotripsy

KW - Retrospective Studies

KW - Treatment Outcome

UR - https://www.hmpgloballearningnetwork.com/site/jic/articles/intravascular-lithotripsy-treatment-calcium-mediated-coronary-stent-restenoses

M3 - SCORING: Journal article

C2 - 33385983

VL - 33

SP - E25-E31

JO - J INVASIVE CARDIOL

JF - J INVASIVE CARDIOL

SN - 1042-3931

IS - 1

ER -