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Intravascular lithotripsy effectiveness and safety in a large real-world cohort
Session:
Sessão de Posters 29 - Intervenção coronária percutânea
Speaker:
Catarina Oliveira
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Simões De Oliveira; Ana Beatriz Garcia; Ana Margarida Martins; Ana Abrantes; Miguel Raposo; Luís Bispo; Alexandra Lopes; José Marques da Costa; José António Duarte; João Silva Marques; Pedro Pinto Cardoso; Fausto J. Pinto
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>:Coronary artery calcification is predictor of early and late adverse outcomes after percutaneous coronary angioplasty (PCI). Intravascular Lithotripsy (IVL) is a promising tool for improving the treatment of calcified lesions.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> to assess effectiveness and safety of IVL in clinical practice.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-center descriptive study of the PCI procedure with prospective assessment of outcomes of consecutive patients that underwent PCI using IVL from March 2021 to October 2023. Procedural success was used as primary effectiveness endpoint. The primary safety endpoint was defined as a composite incidence of cardiac death, myocardial infarction (MI), and target vessel revascularization within 30-days. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 111 patients (80.2% male, mean age 72 ± 9 years) underwent PCI utilizing an IVL. Comorbidities included hypertension (91%), diabetes (55.9%), dyslipidemia (78.4%) and smoking (38.7%). Chronic kidney disease (eGFR <60 ml/min/1.73) was present in 40.5% of patients and 17.8% were on renal replacement therapy. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Indications for PCI spanned the sprectum of chronic (53.2%) and acute coronary syndromes (NSTEMI 20.7%, STEMI 13.5%, , unstable angina 9%). Cardiogenic shock accounted for 2.7% of the indications for PCI and arrhythmic storm 0.9%.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Target lesions were complex including stent restenosis (18%), bifurcations (8.1%) and chronic total occlusions (10.8%) (Table 1). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The majority of patients (84.7%) received IVL following lesion preparation with other calcium-modifying modalities (Graphic 1). Intravascular imaging was used in 21.6% of procedures. More than one IVL balloon were used in 5,4% of the cases. An average of 80 IVL pulses were aplied. Stents were implantated in 93.7% of cases and the remaining were treated with drug-eluting balloons. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The primary effectiveness endpoint was achieved in 99.1%, while the primary safety endpoint incidence was 3.6%. Cardiovascular death occurred in 3 patients and there was a case of acute stent thrombosis. Periprocedural complications, including coronary dissections and perforations, were minimal and resolved following stent implantation (Graphic 2).</span></span></p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif"> This real-world large cohort data of a single center suggests that IVL is an effective and safe technique for the treatment of heavily calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of challenging coronary lesions.</span></span></p>
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