Korean Circ J.  2022 Apr;52(4):288-300. 10.4070/kcj.2021.0155.

Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients

• Wong JJ
• Umapathy S
• Keh YS
• Lau YH
• Yap J
• Idu M
• Chin CY
• Fam JM
• Liew BW
• Chin CT
• Wong PEH
• Koh TH
• Yeo KK

• KMID: 2528023
• DOI: http://doi.org/10.4070/kcj.2021.0155

Abstract

Background and Objectives
We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions.
Methods
Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE).
Results
IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588–4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774–4.718).
Conclusions
These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

Keyword

Lithotripsy; Lithotripsy; Coronary atherectomy; Coronary atherectomy; Percutaneous coronary intervention; Percutaneous coronary intervention

Figure

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  Figure 1 Example of IVL.(A) An acutely under-expanded stent due to concentric calcification despite high pressure OPN balloon dilatation. (B) Markedly improved stent expansion after 30 pulses of a 3.5 mm Shockwave balloon (refer to Supplementary Video 2 for fluoroscopy run).IVL = intravascular lithotripsy.

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