Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry. Issue 4 (2nd August 2022)

• Record Type: Journal Article
• Authors: Kostantinis, Spyridon; Simsek, Bahadir; Karacsonyi, Judit; Davies, Rhian E.; Benton, Stewart; Nicholson, William; Rinfret, Stephane; Jaber, Wissam A.; Raj, Leah; Sandesara, Pratik B.; Alaswad, Khaldoon; Basir, Mir Babar; Megaly, Michael; Khatri, Jaikirshan J.; Young, Laura D.; Jaffer, Farouc A.; Abi Rafeh, Nidal; Patel, Mitul P.; Kerrigan, Jimmy L.; Haddad, Elias V.; Dattilo, Phil; Sandoval, Yader; Schimmel, Daniel R.; Sheikh, Abdul M.; ElGuindy, Ahmed M.; Goktekin, Omer; Mastrodemos, Olga C.; Rangan, Bavana V.; Burke, M. Nicholas; Brilakis, Emmanouil S.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 100:Issue 4(2022)
• Page Start: 512
• Page End: 519
• Publication Date: 2022-08-02
• Subjects: calcified lesions -- chronic total occlusion -- coronary artery disease -- coronary calcification -- intravascular lithotripsy -- percutaneous coronary intervention -- stents -- undilatable lesions; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30354
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: The use of intravascular lithotripsy (IVL) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 82 CTO PCIs that required IVL at 14 centers between 2020 and 2022. Results: During the study period, IVL was used in 82 of 3301 (2.5%) CTO PCI procedures (0.4% in 2020 and 7% in 2022; p for trend < 0.001). Mean patient age was 69 ± 11 years and 79% were men. The prevalence of hypertension (95%), diabetes mellitus (62%), and prior PCI (61%) was high. The most common target vessel was the right coronary artery (54%), followed by the left circumflex (23%). The mean J‐CTO and PROGRESS‐CTO scores were 2.8 ± 1.1 and 1.3 ± 1.0, respectively. Antegrade wiring was the final successful crossing strategy in 65% and the retrograde approach was used in 22%. IVL was used in 10% of all heavily calcified lesions and 11% of all balloon undilatable lesions. The 3.5 mm lithotripsy balloon was the most commonly used balloon (28%). The mean number of pulses per lithotripsy run was 33 ± 32 and the median duration of lithotripsy was 80 (interquartile range: 40−103) seconds. Technical and procedural success was achieved in 77 (94%) and 74 (90%) cases, respectively. Two (2.4%) Ellis Class 2 perforations occurred after IVL use and were managed conservatively. Conclusion: IVL is increasingly being used in CTO PCI with encouraging outcomes.