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Wańha W, Tomaniak M, Wańczura P, Bil J, Januszek R, Wolny R, Opolski MP, Kuźma Ł, Janas A, Figatowski T, Gąsior P, Milewski M, Roleder-Dylewska M, Lewicki Ł, Kulczycki J, Włodarczak A, Tomasiewicz B, Iwańczyk S, Sacha J, Koltowski Ł, Dziarmaga M, Jaguszewski M, Kralisz P, Olajossy B, Sobieszek G, Dyrbuś K, Łebek M, Smolka G, Reczuch K, Gil RJ, Dobrzycki S, Kwiatkowski P, Rogala M, Gąsior M, Ochała A, Kochman J, Witkowski A, Lesiak M, D’Ascenzo F, Bartuś S, Wojakowski W. Intravascular Lithotripsy for the Treatment of Stent Underexpansion: The Multicenter IVL-DRAGON Registry. J Clin Med 2022; 11:jcm11071779. [PMID: 35407387 PMCID: PMC9000023 DOI: 10.3390/jcm11071779] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Whereas the efficacy and safety of intravascular lithotripsy (IVL) have been confirmed in de novo calcified coronary lesions, little is known about its utility in treating stent underexpansion. This study aimed to investigate the impact of IVL in treating stent underexpansion. Methods and Results: Consecutive patients with stent underexpansion treated with IVL entered the multicenter IVL-Dragon Registry. The procedural success (primary efficacy endpoint) was defined as a relative stent expansion >80%. Thirty days device-oriented composite endpoint (DOCE) (defined as a composite of cardiac death, target lesion revascularization, or target vessel myocardial infarction) was the secondary endpoint. A total of 62 patients were enrolled. The primary efficacy endpoint was achieved in 72.6% of patients. Both stent underexpansion 58.5% (47.5−69.7) vs. 11.4% (5.8−20.7), p < 0.001, and the stenotic area 82.6% (72.4−90.8) vs. 21.5% (11.1−37.2), p < 0.001, measured by quantitative coronary angiography improved significantly after IVL. Intravascular imaging confirmed increased stent expansion following IVL from 37.5% (16.0−66.0) to 86.0% (69.2−90.7), p < 0.001, by optical coherence tomography and from 57.0% (31.5−77.2) to 89.0% (85.0−92.0), p = 0.002, by intravascular ultrasound. Secondary endpoint occurred in one (1.6%) patient caused by cardiac death. There was no target lesion revascularization or target vessel myocardial infarction during the 30-day follow-up. Conclusions: In this real-life, largest-to-date analysis of IVL use to manage underexpanded stent, IVL proved to be an effective and safe method for facilitating stent expansion and increasing luminal gain.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
- Correspondence: ; Tel.: +48-32-359-80-00; Fax: +48-32-202-87-54
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland; (M.T.); (Ł.K.); (J.K.)
| | - Piotr Wańczura
- Department of Cardiology, The Ministry of Internal Affairs and Administration Hospital, 35-111 Rzeszów, Poland;
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (R.J.G.)
| | - Rafał Januszek
- Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (R.J.); (S.B.)
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (R.W.); (M.P.O.); (A.W.)
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (R.W.); (M.P.O.); (A.W.)
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.K.); (P.K.); (S.D.)
| | - Adam Janas
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Kraków University, 30-705 Krakow, Poland;
| | - Tomasz Figatowski
- First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.F.); (M.J.)
| | - Paweł Gąsior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
| | - Marek Milewski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
| | - Magda Roleder-Dylewska
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
| | - Łukasz Lewicki
- Department of Invasive Cardiology, University Center for Cardiology, 80-211 Gdansk, Poland;
| | - Jan Kulczycki
- Department of Cardiology, Miedziowe Centrum Zdrowia, 59-300 Lubin, Poland; (J.K.); (A.W.)
| | - Adrian Włodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia, 59-300 Lubin, Poland; (J.K.); (A.W.)
| | - Brunon Tomasiewicz
- Centre for Heart Disease, University Hospital, 50-558 Wroclaw, Poland; (B.T.); (K.R.)
- Department of Heart Disease, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (S.I.); (M.L.)
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland;
| | - Łukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland; (M.T.); (Ł.K.); (J.K.)
| | - Miłosz Dziarmaga
- Department of Cardiology—Intensive Therapy and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland; (T.F.); (M.J.)
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.K.); (P.K.); (S.D.)
| | - Bartosz Olajossy
- 1st Military Hospital in Lublin, 20-049 Lublin, Poland; (B.O.); (G.S.)
| | | | - Krzysztof Dyrbuś
- Third Department of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (K.D.); (M.G.)
| | - Mariusz Łebek
- Upper Silesia Medical Centre, 40-635 Katowice, Poland;
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
| | - Krzysztof Reczuch
- Centre for Heart Disease, University Hospital, 50-558 Wroclaw, Poland; (B.T.); (K.R.)
- Department of Heart Disease, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Robert J. Gil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (R.J.G.)
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (Ł.K.); (P.K.); (S.D.)
| | - Piotr Kwiatkowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | | | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (K.D.); (M.G.)
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland; (M.T.); (Ł.K.); (J.K.)
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (R.W.); (M.P.O.); (A.W.)
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (S.I.); (M.L.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy;
| | - Stanisław Bartuś
- Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (R.J.); (S.B.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (P.G.); (M.M.); (M.R.-D.); (G.S.); (A.O.); (W.W.)
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