Coronary interventions

Coronary lithotripsy for the treatment of underexpanded stents: the international multicentre CRUNCH registry

EuroIntervention 2022;18:574-581. DOI: 10.4244/EIJ-D-21-00545

Maria Tovar Forero
Maria Natalia Tovar Forero1, MD; Gennaro Sardella2, MD, PhD; Nicolò Salvi2, MD; Bernardo Cortese3, MD; Gaetano di Palma3, MD; Nikos Werner4,5, MD, PhD; Adem Aksoy5, MD; Javier Escaned6, MD, PhD; Carlos H. Salazar6, MD; Nieves Gonzalo6, MD, PhD; Fabrizio Ugo7, MD, PhD; Chiara Cavallino7, MD; Tej N. Sheth8, MD, PhD; Isabella Kardys1, MD, PhD; Nicolas M. Van Mieghem1, MD, PhD; Joost Daemen1, MD, PhD
1. Erasmus University Medical Center, Rotterdam, the Netherlands; 2. Policlinico Umberto I' "Sapienza" University of Rome, Rome, Italy; 3. Cardiovascular Research Team, Clinica San Carlo, Milano, Italy and Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; 4. Heart Center, Trier, Germany; 5. Heart Center Bonn, University Hospital, Bonn, Germany; 6. Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain; 7. Sant'Andrea Hospital, Vercelli, Italy; 8. McMaster University, Hamilton, Ontario, Canada

Background: Stent underexpansion increases the risk of cardiac adverse events. At present, there are limited options to treat refractory stent underexpansion. In this context, the intravascular lithotripsy (IVL) system might be a safe and effective strategy.

Aims: We aimed to evaluate the safety and efficacy of IVL in addressing resistant stent underexpansion due to heavy underlying calcification.

Methods: This was an international multicentre registry including patients receiving IVL therapy to treat stent underexpansion from December 2017 to August 2020. Angiographic and intracoronary imaging data were collected. The efficacy endpoint was device success (technical success with a final percentage diameter stenosis <50%). The safety endpoint was in-hospital major adverse cardiac events (MACE).

Results: Seventy patients were included, the mean age was 73±9.2 years and 76% were male. The median time from stent implantation to IVL therapy was 49 days (0-2,537). Adjuvant treatment with non-compliant balloon dilatations pre- and post-IVL was performed in 72.3% and 76.8% of patients, respectively, and additional stenting was performed in 22.4%. Device success was 92.3%. Minimum lumen diameter increased from 1.49±0.73 mm to 2.41±0.67 mm (p<0.001) and stent expansion increased by 124.93±138.19% (p=0.016). No IVL-related procedural complications or MACE were observed. The use of bailout IVL therapy directly after stenting and the presence of ostial underexpanded lesions negatively predicted lumen diameter gain.

Conclusions: Coronary lithotripsy is safe and effective in increasing lumen and stent dimensions in underexpanded stents secondary to heavily calcified lesions.

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coronary artery diseaseintravascular imagingintravascular lithotripsystent underexpansion
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