{"id":8594,"date":"2023-07-31T08:00:00","date_gmt":"2023-07-31T13:00:00","guid":{"rendered":"https:\/\/shockwavemedical.com\/education\/initial-longer-term-outcomes-under-imaging-with-coronary-ivl\/"},"modified":"2024-12-11T09:25:10","modified_gmt":"2024-12-11T15:25:10","slug":"initial-longer-term-outcomes-under-imaging-with-coronary-ivl","status":"publish","type":"post","link":"https:\/\/shockwavemedical.com\/de\/education\/initial-longer-term-outcomes-under-imaging-with-coronary-ivl\/","title":{"rendered":"Initial Longer-term Outcomes Under Imaging with Coronary IVL"},"content":{"rendered":"\n
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Intravascular lithotripsy (IVL) keeps making waves in the clinical community\u2026 a new publication has just been added to the already solid body of data supporting coronary IVL\u2019s safety and efficacy: \u201cMid-Term Angiographic and Intracoronary Imaging Results Following Intracoronary Lithotripsy in Calcified Coronary Artery Disease: Results From Two Tertiary Referral Centres<\/a>\u201d\u00a0was just published in\u00a0Cardiovascular Revascularization Medicine\u00a0journal.\u00a0This recent study dives into mid-term angiographic and intracoronary imaging results post IVL usage, showing\u00a0durable results with preserved stent parameters following IVL.<\/p>\n

We have asked Dr. Angela McInerney, lead author of this publication, to give us a quick snapshot of the study, its key findings and conclusion. Keep on reading to find out more!<\/p>\n

\u00a0<\/p>\n

What was the aim of this study?<\/strong><\/p>\n

IVL has been in use in our institution since 2018 and our experience has been that the acute results were very successful with significant calcium fracture and adequate stent expansion. However, we did not have any data on the longer term results especially vascular healing following the use of this technology. For that reason, we decided to perform angiographic and intracoronary imaging follow up of our patients treated with IVL.<\/p>\n

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How do you summarize the study and its key findings and implications?<\/strong><\/p>\n

In this study, patients who underwent IVL for the treatment of calcified coronary artery disease were invited for repeat angiography with a subgroup also undergoing optical coherence tomography. In total 20 patients participated from two tertiary referral centres.<\/p>\n

At the index IVL procedure, calcium fracture by OCT was seen in 89% of cases and median stent expansion was >90%. Follow up angiography was at a median of 22 months. A binary restenosis rate of 10% was found (2 patients) with only one needing treatment (second patient had a negative physiological assessment).
\nOn paired OCT analysis there was no difference in stent expansion, minimum stent area and minimum lumen area from index to follow up procedure. Neointimal assessment by OCT demonstrated a homogenous neointima with a high backscatter representing health neointimal growth.<\/p>\n

These result suggest durable results with preserved stent parameters following IVL at mid-term follow up with appropriate vascular healing.<\/p>\n

\u00a0<\/p>\n

Why is it important to study the healing patterns after IVL treatment?<\/strong><\/p>\n

IVL is a newly available calcium modification technique. Acutely, IVL results in deep fissuring and fracturing of the calcium allowing stent expansion. How these fractures may heal following stenting was heretofore unknown. Exuberant healing could result in excessive instent restenosis, while lack of stent strut coverage could also increase the risk of stent thrombosis. Understanding the vascular healing following IVL is therefore an important research question which we aimed to answer in this study.<\/p>\n

\u00a0<\/p>\n

What additional insights were you able to conclude out of the OCT substudy?<\/strong><\/p>\n

The OCT substudy demonstrated preserved stent parameters from index procedure to follow up. Parameters assessed included stent expansion and minimum stent area which are two of the most important parameters for predicting stent failure. The paired OCT analysis demonstrated stent expansion of >85% both at index procedure and follow up. Additionally, the OCT findings demonstrated healthy neointimal coverage of stent struts suggesting good vascular healing post IVL use.<\/p>\n

\u00a0<\/p>\n

How will these findings impact your approach to calcium modification?<\/strong><\/p>\n

Durability of PCI outcomes is a very important concern for interventional cardiologists. Particularly in calcified coronary artery disease which as we know is a risk factor for stent failure due to stent under-expansion. We know that adequate calcium modification improves our acute PCI results by allowing stent expansion, but the durability of the result, and avoiding re-interventions, is what is most important for patient care. Overall our findings confirm that modifying calcium using IVL results in not just good acute outcomes, but also, reassuringly, durable longer-term outcomes.<\/p>\n