背景:冠状动脉和外周动脉严重钙化病变,病变准备在支架置入前至关重要,以避免膨胀不足,与长期支架内血栓形成或再狭窄和通畅失败有关。血管内碎石术(IVL)技术通过使用局部脉动声压力波来破坏浅层和深层钙,使其成为冠状动脉床严重钙化患者的有希望的工具。
目的:本研究的目的是系统回顾和总结关于在严重钙化的冠状动脉支架置入前使用IVL制备病变的安全性和有效性的现有数据。
方法:本研究按照PRISMA指南进行。我们系统地搜索了PubMed,Scopus,和Cochrane数据库从开始到2023年2月23日,用于评估支架植入术前接受IVL患者的特征和结局的研究.IVL前后血管腔的直径,以及支架植入,进行了分析。使用随机效应模型评估主要不良心血管事件(MACE)的发生。
结果:这项荟萃分析包括38项研究,包括2977例冠状动脉严重钙化病变患者。平均年龄为72.2±9.1岁,总体IVL临床成功率为93%(95%置信区间[CI]:91%-95%,I2=0%),手术成功率为97%(95%CI:95%-98%,I2=73.7%),而MACE的住院和30天发病率,心肌梗死(MI),死亡率为8%(95%CI:6%-11%,I2=84.5%),5%(95%CI:2%-8%,I2=85.6%),和2%(95%CI:1%-3%,I2=69.3%),分别。IVL应用后立即血管直径显着增加(标准化平均差[SMD]:2.47,95%CI:1.77-3.17,I2=96%),直径狭窄减少(SMD:-3.44,95%CI:-4.36至-2.52,I2=97.5%),同时观察到直径狭窄进一步减少(SMD:-6.57,95%CI:-7.43至-5.72,I2=95.8%),血管直径增加(SMD:4.37,95%CI:3.63-5.12,I2=96.7%)和计算的管腔面积(SMD:3.23,95%CI:2.10-4.37,I2=98%),支架植入后。IVL和支架植入后的平均急性管腔增益估计为1.27±0.6和1.94±1.1mm,分别。围手术期并发症很少见,只有几例穿孔,解剖,或记录无回流现象。
结论:IVL似乎是冠状动脉支架植入前严重钙化病变的安全有效的病变准备策略。现在有必要进行未来的前瞻性研究,以将IVL与其他病变准备策略进行比较。
BACKGROUND: With heavily calcified coronary and peripheral artery lesions, lesion preparation is crucial before stent placement to avoid underexpansion, associated with stent thrombosis or restenosis and patency failure in the long-term. Intravascular lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, making it to a promising tool for patients with severe calcification in coronary bed.
OBJECTIVE: The aim of the study is to systematically
review and summarize available data regarding the safety and efficacy of IVL for lesion preparation in severely calcified coronary arteries before stenting.
METHODS: This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL, as well as stent implantation, were analyzed. The occurrence of major adverse cardiovascular events (MACE) was assessed using a random-effects model.
RESULTS: This meta-analysis comprised 38 studies including 2977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% (95% confidence interval [CI]: 91%-95%, I2 = 0%) and procedural success rate of 97% (95% CI: 95%-98%, I2 = 73.7%), while the in-hospital and 30-days incidence of MACE, myocardial infarction (MI), and death were 8% (95% CI: 6%-11%, I2 = 84.5%), 5% (95% CI: 2%-8%, I2 = 85.6%), and 2% (95% CI: 1%-3%, I2 = 69.3%), respectively. There was a significant increase in the vessel diameter (standardized mean difference [SMD]: 2.47, 95% CI: 1.77-3.17, I2 = 96%) and a decrease in diameter stenosis (SMD: -3.44, 95% CI: -4.36 to -2.52, I2 = 97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: -6.57, 95% CI: -7.43 to -5.72, I2 = 95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63-5.12, I2 = 96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10-4.37, I2 = 98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 and 1.94 ± 1.1 mm, respectively. Periprocedural complications were rare, with just a few cases of perforations, dissection, or no-reflow phenomena recorded.
CONCLUSIONS: IVL seems to be a safe and effective strategy for lesion preparation in severely calcified lesions before stent implantation in coronary arteries. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.