Efficacy of coronary intravascular lithotripsy in coronary stenosis with severe calcification: a systematic review and meta-analysis

• Published in: European heart journal Vol. 42; no. Supplement_1
• Main Authors: Ktenopoulos, N K, Sagris, M, Tzoumas, A T
• Format: Journal Article
• Language: English
• Published: 12-10-2021
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehab724.2085

Abstract
Introduction
Coronary calcification impedes proper stent deployment and expansion leading to an increased risk of adverse outcomes. Coronary Intravascular Lithotripsy (IVL) technology uses localized pulsative sonic pressure waves to disrupt subendothelial calcification and constitutes a promising technique for patients with severe coronary calcification.
Purpose
Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified coronary plaques before stenting.
Methods
This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS and Cochrane databases, from their inception to February 20, 2021 for studies assessing characteristics and outcomes of patients undergoing IVL before stent implantation. A random effects model meta-analysis was performed to assess the diameter of the vessel lumen before and after IVL along with the presence of major adverse cardiac events (MACE).
Results
Eight studies comprising 971 patients were included in this meta-analysis. Mean age was 72.22±8.8 years and the majority of patients were males (78.4%). The overall success rate was 94% (95% CI: 90%-98%), while the in-hospital and 30-days incidence of MACE, MI and death were 8% (95% CI: 3%-14%), 10% (95% CI: 7%-14%), and 1% (95% CI: 0%-1%), respectively. There was a significant increase in the vessel diameter (SMD: 4.03, 95% CI: 3.32–4.74, I2=92%) and the lumen area (SMD: 1.17, 95% CI: 0.78–1.55, I2=84.7%), while decrease was observed in the diameter stenosis (SMD: −6.29, 95% CI: −7.65 to −4.92, I2=96.4%) post-IVL when compared to pre-IVL. Mean acute luminal gain following IVL was estimated to be 1.54±0.5mm.
Conclusions
IVL seems to be an effective and safe technique for preparing severely calcified lesions before PCI. Future prospective cohorts are needed to validate our results.
Funding Acknowledgement
Type of funding sources: None.