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Canadian Journal of Cardiology

Hitting the Rock Behind the Metal: Is Intravascular Lithotripsy for In-Stent Percutaneous Coronary Intervention the Perfect Symphony?

      Coronary artery calcification (CAC) adds technical challenge and complexity to percutaneous coronary interventions (PCIs) and is associated with poorer outcomes and major adverse cardiovascular events.
      • Kawaguchi R.
      • Tsurugaya H.
      • Hoshizaki H.
      • Toyama T.
      • Oshima S.
      • Taniguchi K.
      Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients.
      CAC can lead to stent malapposition, asymmetric expansion, and stent underexpansion, which has been associated with higher rates of device-oriented composite endpoints such as cardiac death, myocardial infarction related to the target vessel, or target-lesion revascularization.
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      References

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      1. Tovar Forero MN, Sardella G, et al. Coronary lithotripsy for the treatment of underexpanded stents: the international multicentre CRUNCH registry. [e-pub ahead of print] EuroIntervention 2022. https://doi.org/10.4222/EIJ-D-21-00545.

      Linked Article

      • In-Stent Use of Intravascular Coronary Lithotripsy for Restenosis and Stent Underexpansion: A Multicentre Experience
        Canadian Journal of Cardiology
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          Percutaneous coronary intervention (PCI) of severe calcified lesions is at high risk of complications (dissection, perforation, stent underexpansion, etc) and suboptimal results have been associated with major cardiac adverse events. Intravascular lithotripsy uses acoustic energy to disrupt the calcified plaque by creating microfractures. The Shockwave C2 (Shockwave Medical Inc, Santa Clara, CA) intravascular lithotripsy system (S-IVL) was approved by the Food and Drug Administration after studies confirming its safety and efficacy.
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