Alfonso Ielasi1, Elisabetta Moscarella2, Luca Testa3, Gaetano Gioffrè4, Gaetano Morabito5, Bernardo Cortese6, Salvatore Colangelo7, Fabrizio Tomai8, Francesco Arioli9, Mauro Maioli10, Massimo Leoncini11, Gabriele Tumminello12, Stefano Benedetto13, Piergiuseppe Greco Lucchina14, Matteo Pennesi15, Fabrizio Ugo7, Elena Viganò6, Mario Bollati3, Bindo Missiroli5, Achille Gaspardone4, Paolo Calabrò2, Francesco Bedogni3, Maurizio Tespili16. 1. Clinical and Interventional Cardiology Unit, Istituto Clinico S.Ambrogio, Milan, Italy. Electronic address: alielasi@hotmail.com. 2. Division of Cardiology, A.O.R.N. "S.Anna e S.Sebastiano" Hospital, Caserta, Italy. 3. Clinical and Interventional Cardiology Unit, IRCCS Policlinico S.Donato, San Donato Milanese, Italy. 4. Cardiology Division, S.Eugenio Hospital, Rome, Italy. 5. Cardiology Division, S.Anna Hospital, Catanzaro, Italy. 6. Cardiology Division, Clinica S. Carlo, Paderno Dugnano, Italy. 7. S.Giovanni Bosco Hospital, Torino, Italy. 8. Department of Cardiovascular Sciences, European Hospital, Roma, Italy. 9. Department of Cardiology, Fatebenefratelli Hospital, Milan, Italy. 10. Division of Cardiology, S.Stefano Hospital, Prato, Italy. 11. Catheterization Laboratory, Sanremo Hospital, Sanremo, Italy. 12. Cardiology Division, S.Andrea Hospital, Vercelli, Italy. 13. Cardiology Division, Galliera Hospital, Genova, Italy. 14. Division of Cardiology, S Croce Hospital, Moncalieri, Italy. 15. Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy. 16. Clinical and Interventional Cardiology Unit, Istituto Clinico S.Ambrogio, Milan, Italy.
Abstract
BACKGROUND: Intravascular lithotripsy (IVL) showed to be effective in dilating heavily calcified de novo coronary lesions but little is known about its performance in under-expanded stents management. Aim of this study was to assess the feasibility, effectiveness and safety of IVL for the treatment of stent underexpansion refractory to balloon dilatation. METHODS: A multicentre, retrospective cohort analysis was performed in patients undergoing IVL to treat under-expanded stents following non-compliant balloon expansion failure. Primary endpoint was successful IVL dilatation defined as IVL balloon delivery and application at the target site followed by an increase of at least 1 mm2 in minimal stent cross-sectional area (MSA) on intracoronary imaging or an increase of at least 20% in minimal stent diameter (MSD) by quantitative coronary analysis (QCA). RESULTS: Thirty-nine under-expanded stents (34 patients) were included. Two cases (5.1%) of multiple stent layers and one (2.5%) acutely under-expanded stent were treated. The median IVL balloon diameter was 3.1 mm (IQR: 2.5-3.5 mm) while the number of pulses emitted was 56.7 (IQR: 30-80). IVL was successful in 34 cases (87.1%), with significant improvement in MSD (post: 3.23 mm [IQR: 3-3.5 mm] vs. pre: 0.81 mm [IQR: 0.35-1.2], p < 0.00001) and MSA (post: 7.61mm2 [IQR: 6.43-7.79mm2] vs. pre: 3.35 [IQR: 2.8-4 mm2], p < 0.00001). Non-fatal peri-procedural ST-elevation myocardial infarction occurred in one case (2.5%) due to IVL balloon rupture. No cardiac death, target lesion revascularization and stent thrombosis occurred in-hospital and at 30-day follow-up. CONCLUSIONS: Bailout IVL was feasible, efficacious and safe to improve refractory stent under-expansion.
BACKGROUND: Intravascular lithotripsy (IVL) showed to be effective in dilating heavily calcified de novo coronary lesions but little is known about its performance in under-expanded stents management. Aim of this study was to assess the feasibility, effectiveness and safety of IVL for the treatment of stent underexpansion refractory to balloon dilatation. METHODS: A multicentre, retrospective cohort analysis was performed in patients undergoing IVL to treat under-expanded stents following non-compliant balloon expansion failure. Primary endpoint was successful IVL dilatation defined as IVL balloon delivery and application at the target site followed by an increase of at least 1 mm2 in minimal stent cross-sectional area (MSA) on intracoronary imaging or an increase of at least 20% in minimal stent diameter (MSD) by quantitative coronary analysis (QCA). RESULTS: Thirty-nine under-expanded stents (34 patients) were included. Two cases (5.1%) of multiple stent layers and one (2.5%) acutely under-expanded stent were treated. The median IVL balloon diameter was 3.1 mm (IQR: 2.5-3.5 mm) while the number of pulses emitted was 56.7 (IQR: 30-80). IVL was successful in 34 cases (87.1%), with significant improvement in MSD (post: 3.23 mm [IQR: 3-3.5 mm] vs. pre: 0.81 mm [IQR: 0.35-1.2], p < 0.00001) and MSA (post: 7.61mm2 [IQR: 6.43-7.79mm2] vs. pre: 3.35 [IQR: 2.8-4 mm2], p < 0.00001). Non-fatal peri-procedural ST-elevation myocardial infarction occurred in one case (2.5%) due to IVL balloon rupture. No cardiac death, target lesion revascularization and stent thrombosis occurred in-hospital and at 30-day follow-up. CONCLUSIONS: Bailout IVL was feasible, efficacious and safe to improve refractory stent under-expansion.
Authors: Angelo Mastrangelo; Giovanni Monizzi; Stefano Galli; Luca Grancini; Cristina Ferrari; Paolo Olivares; Mattia Chiesa; Giuseppe Calligaris; Franco Fabbiocchi; Piero Montorsi; Antonio L Bartorelli Journal: Front Cardiovasc Med Date: 2022-02-21