CRT-100.04 Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Artery Disease: An IVUS Sub-Study

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Background: Coronary intravascular lithotripsy (IVL) has emerged as a novel technique for the treatment of moderate to severely calcified coronary lesions. Previously, the Disrupt CAD III trial evaluated the safety and effectiveness of IVL in facilitating optimal stent implantation. Methods: Disrupt CAD III was a single-arm, prospective, multicenter trial designed to evaluate the safety and effectiveness of the Shockwave IVL coronary catheter to optimize coronary stent deployment in native calcified coronary lesions. The mechanism of calcium modification using intravascular ultrasound (IVUS) was assessed in this substudy. All the comparisons between two intervals in the matched analysis were performed using paired t test or ANOVA test. Results: A total of 40 patients underwent IVUS evaluation, of whom 28 had pre-IVL, 19 post-IVL, and 39 post-stent IVUS evaluation. Pre-procedural minimal lumen area (MLA) was 2.81 ± 0.97 mm2, percent area of stenosis (PSA) was 65.3% ± 19.6 %, and maximum calcium angle was 257.3° ± 81.14°, confirming severe calcification. After IVL treatment, MLA increased to 3.70 ± 1.3 mm2 (p=0.0024), PSA decreased to 54.0% ± 25.28% (p=0.005), and calcium angle decreased to 225.6° ± 77.5° (p=0.0052). The minimum stent area was 8.48 ± 2.92 mm2, and there was a further decrease in PSA to 37.20% ± 42.17% (p<0.0001) post-stenting (Table 1). The success rate of stent delivery, implantation, and post-stent dilatation were 100% post-IVL treatment. Conclusion: IVUS guidance successfully demonstrated the effectiveness of IVL treatment in treating calcified coronary lesions. Further studies with larger cohorts are warranted to confirm these findings. [Formula presented]

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