Coronary calcium has been the bane of percutaneous coronary intervention. It is associated with failure to deliver stents and under-expansion of stents. Moreover, it increases the risk of procedural complications such as coronary dissection and perforation.
Various methods to treat coronary calcium such as atherectomy, scoring balloons and plain balloon angioplasty have unclear clinical benefits as per randomized trials.
An innovative technology using ultrasound in the form of intravascular lithotripsy (IVL) is an alternative, safe and effective pre-treatment to disrupt coronary calcium prior to stent implantation.
The EXIT-CALC study is a small prospective randomized trial of forty patients addressing the effect of pre-treatment of coronary calcium and plaque modification using IVL versus conventional balloon angioplasty on degree of final stent expansion. Optical computed tomography (OCT) was used to objectively evaluate the degree of coronary calcium prior to enrollment in the study.
Only severely calcified coronary arteries (OCT- based calcium score ≥ 4) were included in this study.
The study showed similar efficacy of pre-treatment with IVL as compared to conventional balloon angioplasty on degree of final stent expansion in severely calcified coronary arteries (IVL 83.9% ± 10.3% versus angioplasty 82.2% ± 11.5%, P=0.63). Both forms of treatment had good procedural success and similar major adverse coronary events (MACE) outcomes over 30 days. No procedural complications were noted.
There is no significant difference in the degree of final stent expansion with the use of IVL as compared to conventional percutaneous balloon angioplasty when used for pretreatment of severely calcified coronary arteries.
All editors: Sanjeev Nair, MD, FSCAI
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