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Canadian Journal of Cardiology

REAL-WORLD OUTCOMES IN TREATMENT OF HIGHLY CALCIFIED CORONARY LESIONS WITH INTRAVASCULAR SHOCKWAVE LITHOTRIPSY

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      BACKGROUND

      Intravascular lithotripsy (IVL) has emerged as a novel modality for treatment of highly-calcified coronary lesions. However, real-world data regarding the efficacy and safety of IVL are lacking, particularly for high-risk or complicated coronary lesions. We conducted a study to determine real-world outcomes of IVL in a high-risk population.

      METHODS AND RESULTS

      A retrospective review of consecutive patients who underwent IVL at a tertiary care center between Sep 1, 2019 and Jan 31, 2021 was undertaken. A comprehensive electronic medical record and centralized cardiac catheterization database were used to ascertain clinical and procedural characteristics and outcomes of the patients. The primary outcome was major adverse cardiac events (MACE), defined as death, myocardial infarction, or unplanned target vessel revascularization. Secondary outcomes included angiographic success and freedom from angina. 50 patients, totalling 64 lesions, underwent IVL during the study period. 3 patients suffered in-hospital mortality unrelated to the IVL; there was no other occurrence of MACE in hospital or at 30 days. Angiographic success was near universal (98% of patients with residual stenosis < 50%, and 96% of patients with TIMI 3 flow) and periprocedural complication was very rare. Among patients undergoing IVL of in-stent restenosis (ISR) (n=13) or left main coronary artery (LMCA) (n=12) lesions, angiographic success was universal and there was no occurrence of periprocedural complication or 30-day MACE.

      CONCLUSION

      In a high-risk real-world cohort, including patients with acute coronary syndrome and those undergoing PCI of the LMCA and ISR lesions, IVL was a highly safe and effective treatment for highly-calcified coronary lesions.
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