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Sardella G, Stefanini G, Leone PP, Boccuzzi G, Fovero NT, Van Mieghem N, Giacchi G, Escaned J, Fineschi M, Testa L, Valenti R, Di Mario C, Briguori C, Cortese B, Ribichini F, Oreglia JA, Colombo A, Sangiorgi G, Barbato E, Sonck J, Ugo F, Trani C, Castriota F, Paggi A, Porto I, Tomai F, Mancone M. Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry. Am J Cardiol 2023; 198:1-8. [PMID: 37182254 DOI: 10.1016/j.amjcard.2023.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis <30% by quantitative coronary angiography. Primary safety end point was freedom from serious angiographic complications, which included >National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow <3, and acute thrombosis. A total of 160 patients were enrolled between June 2020 and June 2022. The primary efficacy end point was observed in 155 patients (96.9%). The primary safety end point occurred in 145 cases (90.6%). Dissections >National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow <3 in 3 (1.9%), and perforation in 4 patients (2.5%). Free from inhospital major adverse cardiac and cerebrovascular events, including cardiac death, target vessel myocardial infarction, target lesion revascularization, cerebrovascular accident, definite/probable stent thrombosis, and major bleeding, occurred in 158 patients (98.7%). In conclusion, IVL after RA in lesions with severe CAC was effective and safe, with a very low incidence of complications as either elective or bail-out strategy.
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Affiliation(s)
- Gennaro Sardella
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Giacomo Boccuzzi
- Division of Cardiology, Department of Medicine, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Natalia Tovar Fovero
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | | | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IdISSC, Universidad Complutense de Madrid, C/ Profesor Martín Lagos, Madrid, Spain
| | - Massimo Fineschi
- Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Carlo Briguori
- Division of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Bernardo Cortese
- Foundation for Cardiovascular Research and Innovation, Milan, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jacopo Andrea Oreglia
- Department of Cardiology and de Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
| | | | - Emanuele Barbato
- Cardiology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Anita Paggi
- Laboratory of Interventional Cardiology; Department of Cardiology, S. Anna Hospital, Catanzaro, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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