Safety and efficacy of coronary intravascular lithotripsy for calcified coronary arteries– a systematic review and meta-analysis

ABSTRACT

Objectives: Intravascular lithotripsy (IVL) clinical efficacy and safety in the treatment of calcified coronary artery disease (CAC) is not well known. We sought to assess IVL safety and efficacy in CAC.

Methods: A comprehensive online databases search were performed to identify intravascular lithotripsy studies in patients with coronary artery disease. The primary outcome was IVL related change in the mean pre and post-procedural diameter of the coronary artery.

Results: A total of 4 studies with 282 patients were included. The mean pre-IVL coronary diameter for all patients was 1.01 mm, while the mean post-IVL coronary diameter was 2.70 mm. The mean pre-post IVL diameter difference of coronary arteries on the pooled analysis was significantly lower by 4.08 mm (95% CI −4.94 to −3.30, p ≤ 0.00001). The Overall increase in the post-IVL lumen diameter was significantly higher than the pre-IVL diameter with a mean difference of −4.16 (95% CI −5.08 to −3.24, p = 0.000001). However, compared to pre-IVL, there was a significant reduction in the overall mean difference of luminal calcium angle after IVL of the stented coronary arteries (0.09, 95% CI 0.002–0.16, p = 0.01).

Conclusion: Intravascular lithotripsy can offer a significant improvement in the vessel lumen to facilitate coronary stent delivery and deployments in severely calcified coronary arteries.

KEYWORDS:

• Lithotripsy
• intravascular lithotripsy
• shockwave Intravascular Lithotripsy
• coronary artery calcification
• left coronary circulation

Article highlights

• Intravascular lithotripsy can yield significant lumen gain of up to 4.16mm by disrupting the calcium in the media and intima coronary arteries.

• IVL has the best yield in severe CAC with stenosis >50%, and calcium angle >270 degrees as seen on intravascular imaging, facilitating stent delivery and preventing coronary recoil.

Intra-coronary imaging helps characterize and evaluate coronary calcification and guide IVL therapy in patients with severely calcified lesions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded