K.F.C.LI1, E.SIM1, H.H.HO1
Tan Tock Seng Hospital1
Background: Calcified coronary artery lesions pose challenges to device delivery and procedural success in percutaneous coronary intervention (PCI). Shockwave intravascular lithotripsy (IVL) is a new technology that utilises pulsatile mechanical energy to disrupt calcified coronary lesions. Drug-coated balloon (DCB) angioplasty is a feasible treatment option in PCI with an attractive strategy of leaving nothing behind. There is limited data on the outcomes of a novel combination of IVL and DCB angioplasty for treatment of calcified coronary arteries.
Methods: We retrospectively reviewed all patients treated with IVL and DCB angioplasty during PCI for de-novo calcific coronary lesions between September 2019 to March 2021.
Results: A total of 7 patients underwent IVL and DCB-only PCI (71% male, mean age 81). Indications for PCI include acute coronary syndrome (72%), heart failure (14%) and angina (14%). Mean baseline left ventricular ejection fraction was 42 + 15%. Angiographic success (<30% residual stenosis) occurred in 6 patients (86%), while 1 patient had residual 50% stenosis. No major intraprocedural complications were recorded. Major adverse cardiac event occurred in 1 patient (14%), who died due to end stage heart failure at 7 months. No cases of myocardial infarction, target vessel revascularisation and lesion thrombosis were reported.
Conclusion: Our preliminary experience shows that novel use of IVL and DCB-only angioplasty for treatment of calcified coronary arteries is safe and feasible with low event rate (intra-procedure and follow-up). However, more data are required to establish the long-term safety and efficacy of this novel “all-balloon” approach.