Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative. (15th October 2022)

• Record Type: Journal Article
• Authors: Honton, Benjamin; Lipiecki, Janusz; Monségu, Jacques; Leroy, Fabrice; Benamer, Hakim; Commeau, Philippe; Motreff, Pascal; Cayla, Guillaume; Banos, Jean Luc; Bouchou, Gael; Laperche, Clémence; Farah, Bruno; Rangé, Grégoire; Lefèvre, Thierry; Amabile, Nicolas
• Is Part Of: International journal of cardiology. Volume 365(2022)
• Page Start: 106
• Page End: 111
• Publication Date: 2022-10-15
• Subjects: Intravascular lithotripsy -- Coronary calcification -- In-stent restenosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.07.023
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. Methods: Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. Results: A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. Conclusions: In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted. Highlights: A total of 220 lesions (76.7% de novo lesions / DNL and 23.3% intra stentrestenosis/ISR) were treated by intravascular lithotripsy in 202 patients. Procedural success was achieved in 95.5% of patients, with no difference between DNL and ISR groups (96.5% vs 92%; p=0.24). MACE-free survival at 1 year was 86.6% in the overall cohort, with no difference between DNL and ISR (91.5% vs 83.8%; p = 0.15).