Shattering the Status Quo: Intravascular Lithotripsy’s Role in Cardiology
When it comes to treating under-expanded coronary stents, a recent meta-analysis offers promising insights. Let’s delve into the findings and their implications for the field of cardiology.
The Source Article Details
A Systematic Review and Meta-Analysis Including 354 Patients from 13 Studies of Intravascular Lithotripsy for the Treatment of Underexpanded Coronary Stents by Rodolfo Caminiti et al. in 2023.
Cited By: 1 (Updated: November 27, 2023)
The Source Article's Abstract
Background
Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologists. Stent underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis.
Methods
In this meta-analysis, the primary end point was IVL strategy success, defined as the adequate expansion of the underexpanded stent. Random-effects models weighted by inverse variance were used because of clinical heterogeneity.
Results
This meta-analysis included 13 studies with 354 patients. Strategy success was seen in 88.7% of patients. The rate of intraprocedural complications was 1.6%.
Conclusion
The 'stent-through' IVL plaque modification technique is a safe tool to treat SU caused by CCP, with a high success rate and a very low incidence of complications.
The Source Article References
- Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients by Kawaguchi, 2008 in Cardiovasc Revasc Med
- Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a Harmonizing Outcomes with revascularization and Stents in acute myocardial infarction (HORIZONS-AMI) substudy by Choi, 2011 in Circ Cardiovasc Interv
- In-stent restenosis characteristics and repeat stenting underexpansion: insights from optical coherence tomography by Yin, 2020 in EuroIntervention
- Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: multicentre CRACK registry by Wańha, 2021 in PLoS One
- Safety and efficacy of rotational atherectomy for the treatment of undilatable underexpanded stents implanted in calcific lesions by Ferri, 2017 in Catheter Cardiovasc Interv
- Rotational atherectomy of undilatable coronary stents: stentablation, a clinical perspective and recommendation by Édes, 2016 in EuroIntervention
- Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion by Neupane, 2021 in Catheter Cardiovasc Interv
- Safety and efficacy of stentablation with rotational atherectomy for the management of underexpanded and undilatable coronary stents by Whiteside, 2019 in Cardiovasc Revasc Med
- Excimer laser LEsion modification to expand non-dilatable sTents: the ELLEMENT registry by Latib, 2014 in Cardiovasc Revasc Med
- The coronary intravascular lithotripsy system by Forero, 2019 in Interv Cardiol
- Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses by Brinton, 2019 in Circulation
- Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses: the disrupt CAD II study by Ali, 2019 in Circ Cardiovasc Interv
- Intravascular lithotripsy for treatment of severely calcified coronary artery disease by Hill, 2020 in J Am Coll Cardiol
- IntravaScular lithotripsy for the management of UndILatable coronary StEnt: the SMILE registry by Ielasi, 2020 in Cardiovasc Revasc Med
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration by Liberati, 2009 in PLoS Med
- Meta-analysis in clinical trials by DerSimonian, 1986 in Control Clin Trials
- Management of stent underexpansion using intravascular lithotripsy-Defining the utility of a novel device by Yeoh, 2021 in Catheter Cardiovasc Interv
- Intravascular lithotripsy in calcified coronary lesions: a prospective, observational, multicenter registry by Aksoy, 2019 in Circ Cardiovasc Interv
- Resolving chronic stent under-expansion in calcified lesions by intravascular lithoplasty by Yaginuma, 2020 in J Cardiol Cases
- Intravascular lithotripsy in calcified-coronary lesions: a real-world observational, European multicenter study by Aziz, 2021 in Catheter Cardiovasc Interv
Citing the Source Article (APA)
Caminiti, R., Vetta, G., Parlavecchio, A., Ielasi, A., Magnocavallo, M., Della Rocca, D.G., Cerrato, E., Carerj, S., Di Bella, G., Micari, A., Vizzari, G. (2023). A Systematic Review and Meta-Analysis Including 354 Patients from 13 Studies of Intravascular Lithotripsy for the Treatment of Underexpanded Coronary Stents. The American Journal of Cardiology, 205, 223-230. 10.1016/j.amjcard.2023.07.144
The Heart of the Matter: What’s the Issue with Underexpanded Stents?
Stent under expansion is often linked to calcified coronary plaque, leading to complications like stent thrombosis and in-stent restenosis. The study aims to evaluate the effectiveness of intravascular lithotripsy (IVL) in addressing this issue.
IVL is compared to other treatments like high-pressure noncompliant balloons and rotational atherectomy, among others.
Breaking Down the Numbers: What Does the Data Say?
- Study Scope: 13 studies, 354 patients
- Success Rate: 88.7%
- Complication Rate: 1.6%
The study reveals that IVL has a high success rate and a very low incidence of complications, making it a viable option for treating under-expanded stents.
PP-ICONS: A Quick Evaluation
- Problem: Stent under-expansion in coronary arteries
- Intervention: Intravascular lithotripsy (IVL)
- Comparison: High-pressure noncompliant balloons, rotational atherectomy
- Outcome: Adequate stent expansion
- Number of Subjects: 354 patients
- Statistics: 88.7% success rate, 1.6% complication rate
Implications and Future Directions
The study’s findings could revolutionize the way cardiologists approach stent underexpansion. With a high success rate and minimal complications, IVL stands as a strong contender in the treatment arsenal.
However, more long-term studies are needed to validate these results and explore potential drawbacks.
What are your thoughts on the potential of IVL in treating under-expanded stents? Could this be the game-changer we’ve been waiting for? Feel free to leave your comments below.