Endovascular intravascular lithotripsy in the treatment of calcific common femoral artery disease: A case series with an 18-month follow-up

• Published in: Cardiovascular revascularization medicine Vol. 43; pp. 80 - 84
• Main Authors: Baig, Muhammad, Kwok, Michael, Aldairi, Ammer, Imran, Hafiz M., Khan, Mohammad S., Moustafa, Abdelmoniem, Hyder, Omar N., Saad, Marwan, Aronow, Herbert D., Soukas, Peter A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2022
• Subjects: Atherectomy; Common femoral artery; Intravascular lithotripsy; CLTI; DCB; Atherectomy; Common femoral artery; CD-TLR; IVL; CFA; Intravascular lithotripsy
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2022.05.003

Intravascular lithotripsy (IVL) is a novel endovascular treatment for calcified common femoral artery disease (CFA). Data on midterm effectiveness for clinically driven target lesions revascularization (CD-TLR) is lacking. This study investigated CD-TLR during 18-month follow-up in patients requiring IVL for CFA disease treatment.
In a single-center retrospective cohort study, electronic medical record of patients undergoing IVL for CFA disease from January 2018 to March 2020 were reviewed. Primary outcome was CD-TLR estimated by Kaplan-Meier method during 18-month follow-up. Univariate logistic regression was used to compare differences in CD-TLR by the type of adjunct therapy used.
Among 54 CFA lesions in 50 patients, mean age (SD) was 75(8) years, gender and race were predominantly male (74%, n = 37) and white (94%, n = 47), respectively. Rutherford class III claudication was most common (70%, n = 35) with mean ABI of 0.66 (0.26) and mean angiographic stenosis of 77% (13%). Adjunct use of drug-coated balloon (DCB) angioplasty was 83% (n = 45) and atherectomy was 39% (n = 21). Residual angiographic stenosis was <30% in all cases. Complications included dissection requiring stent placement (2%, n = 1). After 18-months, 18% (n = 9) died unrelated to procedural complications and 6% (n = 3) were lost to follow-up. 18-month cumulative freedom from CD-TLR was 80.6% (95% CI: 69.1%, 92%). Univariate logistic regression did not reveal a statistically significant difference in CD-TLR with type of adjunct therapy used (p > 0.05).
IVL with adjunct use of DCB and/or atherectomy is safe and effective in treatment of calcified CFA disease. Randomized studies are required to confirm these findings.
•Adjunct use of intravascular lithotripsy for treatment of symptomatic calcified CFA disease was found to be safe and effective in CFA disease treatment.•Cumulative CD-TLR of 16.6% at 18-month follow up is comparable to prior studies involving IVL in peripheral arterial disease.•Multimodal intervention involving intravascular lithotripsy, drug-coated balloon angioplasty and atherectomy can be applied in treatment of heavily calcified CFA lesions, with acceptable safety and effectiveness profile.