Intravascular lithotripsy and temporary mechanical circulatory support for the treatment of heavily calcified coronary artery disease: insights from the BENELUX-IVL registry

Heart & Lung, vol. 73, pp. 108–113

Abstract

BACKGROUND: Intravascular lithotripsy (IVL) is increasingly utilized for the treatment of heavily calcified coronary lesions. However its use in conjunction with temporary mechanical circulatory support (tMCS) remains underexplored. OBJECTIVE: This study aims to evaluate the current use of tMCS and IVL for the treatment of heavily calcified coronary lesions. METHOD: From the BENELUX-IVL prospective registry, patients who underwent IVL during PCI and required tMCS during the procedure were selected. The primary technical endpoint was procedural success <30%, defined as a composite of device success (the ability to deliver the IVL catheter across the target lesion, and delivery of IVL pulses without angiographic complications) with residual stenosis <30%, final Thrombolysis In Myocardial Infarction grade 3 flow, and no in-hospital major adverse cardiovascular events (MACE). The primary clinical outcome was in-hospital MACE, including cardiac death, non-fatal myocardial infarction, or target lesion revascularization. RESULTS: Between May 2019 and March 2024, a total of 454 patients were included, of whom 12 (2.6%) necessitated tMCS (for a total of 13 tMCS devices). Upon admission, the mean LV-EF was 39.5 ± 11.9%. The median Syntax score was 37 (25-49). A bail-out indication was the most common reason for tMCS initiation (58.3%), even if none was directly started due to IVL-related complications. Microaxial Flow Pump was the main utilized device (75%), followed by VA-ECMO (25%) and IABP (8.3%). One case required both VA-ECMO and Impella due to a coronary perforation complicated by cardiac tamponade. Procedural success < 30% was achieved in 91.6% of the cases. MACE occurred in one patient (8.3%). CONCLUSION: In a large cohort of patients with complex heavily calcified coronary lesions requiring IVL, the need for tMCS was low (2.6%), with the main indication being bail-out.

Authors 13

1. Federico Oliveri corresponding Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: federico.md.oliveri@gmail.com

2. Isabel Guerra Merino

   Hospital Universitario Virgen del Rocío

   Affiliation as printed

   Department of Cardiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain

3. Ibtihal Al Amri Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

4. Brian O. Bingen Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

5. Fatih Arslan Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

6. Bimmer E.P.M. Claessen

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Cardiology, Amsterdam University Medical Center, the Netherlands

7. Aukelien C. Dimitriu‐Leen

   Radboud University Medical Center

   Affiliation as printed

   Department of Cardiology, Radboud University Medical Center, the Netherlands

8. Joëlle Kefer

   Cliniques Universitaires Saint-Luc · Fondation Saint-Luc

   Affiliation as printed

   Department of Cardiology, Saint-Luc Bruxelles, Belgium

9. Hany Girgis

   Jeroen Bosch Ziekenhuis

   Affiliation as printed

   Department of Cardiology, Jeroen Bosch Ziekenhuis, Den-Bosch, the Netherlands

10. Tessel N. E. Vossenberg

    Medisch Centrum Leeuwarden

    Affiliation as printed

    Department of Cardiology, Medisch Centrum Leeuwarden, the Netherlands

11. Frank van der Kley Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

12. J. Wouter Jukema Aachen

    Leiden University Medical Center · Netherlands Heart Institute

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute. Utrecht. The Netherlands, the Netherlands

13. José M. Montero Cabezas Aachen Department of Cardiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands