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Intravascular lithotripsy in peripheral lesions with severe calcification and its use in TAVI procedure - a meta-analysis.
Sagris, Marios; Ktenopoulos, Nikolaos; Soulaidopoulos, Stergios; Dimitriadis, Kyriakos; Papanikolaou, Angelos; Tzoumas, Andreas; Terentes-Printzios, Dimitrios; Lichtenberg, Michael; Korosoglou, Grigorios; Toutouzas, Konstantinos; Honton, Benjamin; Tousoulis, Dimitris; Tsioufis, Konstantinos.
Afiliación
  • Sagris M; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Ktenopoulos N; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Soulaidopoulos S; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Dimitriadis K; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Papanikolaou A; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Tzoumas A; Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Terentes-Printzios D; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Lichtenberg M; Vascular Center Arnsberg, Germany.
  • Korosoglou G; Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital, Weinheim, Germany.
  • Toutouzas K; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Honton B; Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
  • Tousoulis D; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
  • Tsioufis K; First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Vasa ; 53(4): 263-274, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38934125
ABSTRACT

Background:

Heavily calcified peripheral artery lesions increase the risk of vascular complications, constituting a severe challenge for the operator during catheter-based cardiovascular interventions. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and represents a promising technique for plaque modification in patients with severe calcification in peripheral arteries.

Purpose:

Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified peripheral arteries and its use in Transcatheter Aortic Valve Implantation (TAVI). Patients and

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 in the peripheral vasculature. The diameter of the vessel lumen before and after IVL was estimated. The occurrence of peri-procedural complications was assessed using a random-effects model.

Results:

20 studies with a total of 1,223 patients with heavily calcified peripheral lesions were analysed. The mean age of the cohort was 70.6 ± 17.4 years. Successful IVL delivery achieved in 100% (95% CI 100%-100%, I2 = 0%), with an increase in the luminal diameter (SMD 4.66, 95% CI 3.41-5.92, I2 = 90.8%) and reduction in diameter stenosis (SMD -4.15, 95% CI -4.75 to -3.55, I2 = 92.8%), and a concomitant low rate of complications. The procedure was free from dissection in 97% (95% CI 91%-100%, I2 = 81.4%) while dissections of any type (A, B, C, or D) were observed in 6% (95% CI 2%-10%, I2 = 85.3%) of the patients. Several rare cases of abrupt closure, no-reflow phenomenon, perforation, thrombus formation, and distal embolization were recorded. Finally, the subgroup analysis of patients who underwent a TAVI with IVL assistance presented successful implantation in 100% (95% CI 100%-100%, I2 = 0%) of the cases, with only 4% (95% CI 0%-12%, I2 = 68.96%) presenting dissections of any sort.

Conclusions:

IVL seems to be an effective and safe technique for modifying severely calcified lesions in peripheral arteries and it is a promising modality in TAVI settings. Future prospective studies are needed to validate our results.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Índice de Severidad de la Enfermedad / Litotricia / Enfermedad Arterial Periférica / Calcificación Vascular / Reemplazo de la Válvula Aórtica Transcatéter Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Vasa Año: 2024 Tipo del documento: Article País de afiliación: Grecia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
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XML
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Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Índice de Severidad de la Enfermedad / Litotricia / Enfermedad Arterial Periférica / Calcificación Vascular / Reemplazo de la Válvula Aórtica Transcatéter Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Vasa Año: 2024 Tipo del documento: Article País de afiliación: Grecia Pais de publicación: Suiza