Abstract：
Calcified coronary plaque (CCP) represents a challenging scenario for interventional cardiologists. Stent underexpansion (SU), often associated with CCP, can predispose to stent thrombosis and in-stent restenosis. To date, SU with heavily CCP can be addressed using very high-/high-pressure noncompliant balloons, off-label rotational atherectomy/orbital atherectomy, excimer laser atherectomy, and intravascular lithotripsy (IVL). In this meta-analysis, we investigated the success rate of IVL for the treatment of SU because of CCP. Studies and case-based experiences reporting on the use of IVL strategy for treatment of SU were included. The primary end point was IVL strategy success, defined as the adequate expansion of the underexpanded stent. A metanalysis was performed for the main focuses to calculate the proportions of procedural success rates with corresponding 95% confidence intervals (CIs). Random-effects models weighted by inverse variance were used because of clinical heterogeneity. This meta-analysis included 13 studies with 354 patients. The mean age was 71.3 years (95% CI 64.9 to 73.1), and 77% (95% CI 71.2% to 82.4%) were male. The mean follow-up time was 2.6 months (95% CI 1 to 15.3). Strategy success was seen in 88.7% (95% CI 82.3 to 95.1) of patients. The mean minimal stent area was reported in 6 studies, the pre-IVL value was 3.4 mm2 (95% CI 3 to 3.8), and the post-IVL value was 6.9 mm2 (95% CI 6.5 to 7.4). The mean diameter stenosis (percentage) was reported in 7 studies, the pre-IVL value was 69.4% (95% CI 60.7 to 78.2), and the post-IVL value was 14.6% (95% CI 11.1 to 18). The rate of intraprocedural complications was 1.6% (95% CI 0.3 to 2.9). In conclusion, the \"stent-through\" IVL plaque modification technique is a safe tool to treat SU caused by CCP, with a high success rate and a very low incidence of complications.
摘要：
钙化冠状动脉斑块（CCP）对于介入心脏病学家来说是一个具有挑战性的场景。支架膨胀不足（SU），经常与CCP联系在一起，可能导致支架内血栓形成和支架内再狭窄。迄今为止,可以使用非常高/高压力的非顺应性气球来解决具有严重CCP的SU，标示外旋磨/眼眶旋磨,准分子激光旋切术,和血管内碎石术（IVL）。在这个荟萃分析中，我们调查了IVL治疗因CCP引起的SU的成功率。包括关于使用IVL策略治疗SU的研究和基于病例的经验报告。主要终点是IVL策略成功，定义为扩张不足的支架的充分扩张。对主要焦点进行元分析，以计算手术成功率的比例以及相应的95％置信区间（CI）。由于临床异质性，使用了逆方差加权的随机效应模型。这项荟萃分析包括13项研究，涉及354名患者。平均年龄为71.3岁(95%CI为64.9至73.1)，77％（95％CI71.2％至82.4％）为男性。平均随访时间为2.6个月（95％CI1至15.3）。88.7%(95%CI82.3~95.1)的患者策略成功。6项研究报告了平均最小支架面积，IVL前值为3.4mm2(95%CI3至3.8)，IVL后值为6.9mm2（95%CI6.5至7.4）。在7项研究中报告了平均直径狭窄（百分比），IVL前值为69.4%（95%CI60.7至78.2），IVL后值为14.6%（95%CI11.1至18）。术中并发症的发生率为1.6％（95％CI0.3至2.9）。总之,“通过支架”IVL斑块修饰技术是治疗CCP引起的SU的安全工具，成功率高，并发症发生率很低。
