The effectiveness of Intravascular Lithotripsy after sub-optimal non-compliant balloon inflation for treating calcified coronary lesions

Watson, Evan, van Wyk, Aléchia ORCID: https://orcid.org/0000-0001-6823-088X and Davies, John (2022) The effectiveness of Intravascular Lithotripsy after sub-optimal non-compliant balloon inflation for treating calcified coronary lesions. In: 37th European Cardiology Conference, 31 Oct - 01 Nov 2022, London. . [Conference or Workshop Item]

Abstract

Background
Coronary arterial calcification (CAC) is a significant manifestation associated with atherosclerosis that results in poor clinical and patient outcomes (Budoff et al., 2007; Raggi et al., 2008). Moreover, CAC hinders percutaneous coronary intervention (PCI) for vessel revascularisation, with stent under-expansion and malposition not uncommon (Mousa et al., 2005). Many lesion preparation techniques have been developed, including non-compliant (NC) balloon angioplasty, accompanying debated effectiveness and an increased risk of procedural complications (Barbato et al., 2017). Therefore, the need for a low-risk yet effective CAC modification technique has resulted in the development of Intravascular Lithotripsy (IVL), delivering pressure waves to fracture calcification, and creating greater vessel compliance for stent deployment.

Objectives
This study aimed to evaluate the implementation of IVL after suboptimal NC-balloon inflation for modifying calcified lesions as part of PCI, with vessel measurements as part of a detailed clinical assessment.

Methods
This was a retrospective study acquiring the data of patients (n=30) who underwent IVL therapy after suboptimal NC-balloon inflation as part of PCI. IVL performance was assessed by procedural success (vessel stenosis <50%, <30%, 20%), quantified using angiography, intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Results
Procedural success was observed in 93% of cases, with 80% ending with <30% stenosis and 47% with <20%. A significant difference was found between lumen diameter measurements after each stage of PCI (H(3)=86.64, p<0.001), with the largest difference observed between pre-procedure and post-stent-deployment. IVUS measurements revealed a significant difference between lumen diameter pre-procedure and post-stent deployment (t=-12.84, p<0.001). OCT measurements revealed a significant difference between lumen diameter and area measurements pre-and post-procedure [F(2,3)=10.70, p=0.043; F(2,3)=17.06, p=0.023].

Conclusion
IVL therapy is an effective lesion preparation technique superior to conventional balloon angioplasty facilitating successful stent deployment. Future research should assess IVL from larger samples employing more routine implementation of intravascular imaging mediating detailed procedural assessment.

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