Shattering the Status Quo: Intravascular Lithotripsy’s Role in 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
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.
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.
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%.
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
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- 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 WaÅha, 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
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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.