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. 2024 Dec 2;20(23):e1454-e1464.
doi: 10.4244/EIJ-D-24-00282.

Outcomes of coronary intravascular lithotripsy for the treatment of calcified nodules: a pooled analysis of the Disrupt CAD studies

Ziad A Ali  1   2   3 , Doosup Shin  1 , Mandeep Singh  1 , Sarah Malik  1 , Koshiro Sakai  1 , Benjamin Honton  4 , Dean J Kereiakes  5 , Jonathan M Hill  6 , Shigeru Saito  7 , Carlo Di Mario  8 , Nieves Gonzalo  9 , Robert F Riley  10 , Akiko Maehara  1   2 , Mitsuaki Matsumura  2 , Jason Hokama  11 , Nick E J West  11 , Gregg W Stone  12 , Richard A Shlofmitz  1
Affiliations

Outcomes of coronary intravascular lithotripsy for the treatment of calcified nodules: a pooled analysis of the Disrupt CAD studies

Ziad A Ali et al. EuroIntervention. .

Abstract

Background: Coronary intravascular lithotripsy (IVL) safely facilitates stent implantation in severely calcified lesions.

Aims: This analysis sought to determine the relative impact of IVL on acute and long-term outcomes specifically in calcified nodules (CNs).

Methods: Individual patient-level data (N=155) were pooled from the Disrupt CAD optical coherence tomography (OCT) substudies. Severely calcified lesions with and without CNs were compared by OCT for acute procedural results and for target lesion failure (TLF) at 2 years - a composite of cardiac death, target vessel myocardial infarction, and ischaemia-driven target lesion revascularisation.

Results: A CN was identified in 18.7% (29/155) of lesions. When comparing lesions with and without CNs, there were no significant differences in preprocedure minimal lumen area or diameter stenosis; however, the mean calcium angle and calcium volume were greater in CN lesions. Despite a higher calcium burden, the final minimal stent area (CN: 5.7 mm2 [interquartile range [IQR] 4.4, 8.3] vs non-CN: 5.7 mm2 [IQR 4.7, 7.2]; p=0.80) and stent expansion (CN: 79.3% [IQR 64.3, 87.0] vs 80.2% [IQR 68.9, 92.4]; p=0.30) were comparable between the two groups. In the CN group, the final stent area and expansion at CN sites were 7.6 mm2 (IQR 5.5, 8.5) and 89.7% (IQR 79.8, 102.5), respectively. The cumulative incidence of TLF at 2 years was 13.9% and 8.0% in the CN and non-CN groups, respectively (p=0.32).

Conclusions: Despite a greater calcium volume in CNs, IVL use was associated with comparable stent expansion and luminal gain in both CN and non-CN lesions. Further studies powered for clinical outcomes comparing different plaque modification techniques in this lesion subset are warranted.

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Conflict of interest statement

Z.A. Ali reports institutional grants from Abbott, Abiomed, ACIST Medical, Boston Scientific, Cardiovascular Systems Inc., Medtronic, Opsens Medical, Philips, and Shockwave Medical; personal fees from Amgen, AstraZeneca, and Boston Scientific; and equity in Elucid, Lifelink, SpectraWAVE, Shockwave Medical, and VitalConnect. B. Honton reports research grant from Shockwave Medical; consulting fees from Shockwave Medical and Abbott; and payment or honoraria from Terumo, Abbott, and Medtronic. D.J. Kereiakes reports personal consulting fees from Shockwave Medical, Elixir Medical, and Boston Scientific. J. Hokama has received consulting fees/honoraria from Abbott, Boston Scientific, and Abiomed; is an employee of Shockwave Medical; and has received equity/stock options from Shockwave Medical. S. Saito is a consultant for Japan Lifeline. C. Di Mario reports research grants from Amgen, CSL Behring, Chiesi, Daiichi Sankyo, Edwards Lifesciences, Medtronic, and Shockwave Medical. N. Gonzalo reports a research grant from Abbott; and consultancy and speaker fees from Abbott, Boston Scientific, Philips, and Shockwave Medical. R.F. Riley reports honoraria from Boston Scientific, Asahi Intecc, and Medtronic. A. Maehara reports grant support from Abbott and Boston Scientific; and consultant fees from Abbott, Boston Scientific, and Conavi Medical, Inc. M. Matsumura reports consulting fees from Terumo and Boston Scientific. G.W. Stone has received speaker honoraria from Medtronic, Pulnovo, and Infraredx; and has served as a consultant to Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Abiomed, Ancora, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Cardiomech, Gore, Amgen, Adona Medical, and Millennia Biopharma; and has equity/options in Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWAVE, Orchestra Biomed, Aria, Cardiac Success, Valfix, and Xenter; his daughter is an employee at Medtronic; institutional disclosure: his employer, Mount Sinai Hospital, receives research support from Abbott, Abiomed, Bioventrix, Cardiovascular Systems Inc, Philips, Biosense Webster, Shockwave Medical, Vascular Dynamics, Pulnovo, and V-wave. J.M. Hill reports speaker honoraria and institutional grants from Abbott, Abiomed, Boston Scientific, and Shockwave Medical; and equity from Shockwave Medical. N.E.J. West is an employee of Shockwave Medical. All the other authors report nothing to disclose relevant to the present manuscript.

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