1. IntravaScular Lithotripsy for the Management of UndILatable Coronary StEnt: The SMILE Registry
- Author
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Gabriele Tumminello, Paolo Calabrò, Achille Gaspardone, Piergiuseppe Greco Lucchina, Luca Testa, Francesco Arioli, Fabrizio Ugo, Bindo Missiroli, Fabrizio Tomai, Mauro Maioli, Massimo Leoncini, Bernardo Cortese, Elisabetta Moscarella, Salvatore Colangelo, Alfonso Ielasi, Francesco Bedogni, Maurizio Tespili, Stefano Benedetto, Matteo Pennesi, Gaetano Morabito, Mario Bollati, Gaetano Gioffrè, Elena Vigano, Ielasi, A., Moscarella, E., Testa, L., Gioffre, G., Morabito, G., Cortese, B., Colangelo, S., Tomai, F., Arioli, F., Maioli, M., Leoncini, M., Tumminello, G., Benedetto, S., Lucchina, P. G., Pennesi, M., Ugo, F., Vigano, E., Bollati, M., Missiroli, B., Gaspardone, A., Calabro, P., Bedogni, F., and Tespili, M.
- Subjects
medicine.medical_specialty ,Percutaneous coronary interventions ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Lithotripsy ,Coronary Angiography ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Coronary stent ,medicine ,Clinical endpoint ,Humans ,In patient ,Registries ,030212 general & internal medicine ,Vascular Calcification ,Retrospective Studies ,business.industry ,Intravascular lithotripsy, stent underexpansion, drug eluting stent ,Stent ,Retrospective cohort study ,General Medicine ,Surgery ,Treatment Outcome ,Stents ,Cardiology and Cardiovascular Medicine ,business - 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.
- Published
- 2020