L’utilizzo delle tecniche di Aterectomia e Litotrissia per il trattamento di lesioni coronariche calcifiche: risultati intraprocedurali e a distanza in due centri ad alto volume

In-hospital and long-term clinical outcomes of rotational atherectomy and intravascular lithotripsy in patients with complex calcified coronary lesions: a double-center registry. Background: Rotational atherectomy (RA) can favorably modify heavily calcified coronary lesions with known results; new technologies are currently at our disposal in this setting of patients but real-world data are lacking. Objectives: To assess procedural and long-term outcomes of RA and intravascular lithotripsy (IVL) in a cohort of patients with complex calcified coronary lesions. Methods and Results: We retrospectively collected data regarding all patients treated with RA and IVL (separately or in combination). Follow-up was obtained by clinic visit or telephone interview. Seventy patients with de novo complex calcified coronary lesions treated with RA and/or IVL (64 RA; 8 IVL; 2 combined RA+IVL treatment) were analyzed. Mean age was 72.5 ± 9.5 years, 38 patients (55.1%) had diabetes mellitus and 30 patients (43.5%) had chronic renal failure. Total stent length/patient was 52.5 mm. Angiographic success rate was 97%, with only 1 case of RA failure due to massive calcification. The incidence of in-hospital major adverse cardiac events (MACE), defined as death, myocardial infarction (MI), and target vessel revascularization (TVR), was 2.9%, driven by death in 2 complex fragile patients. Long-term follow-up was available for 40 patients (60% of entire population). At a median follow-up period of 12.5 months (range 2-36), the cumulative incidence of MACE was 17.5%, with Kaplan-Meier MACE-free survival rate of 84% (95% CI 0.72-0.98). Death occurred in 7.5% (cardiac death only 2.5%), MI in 10.0% and target lesion revascularization (TLR) in 10.0% (MI/TLR overlap in 3 out of 4). One definite (2.5%) and one probable (2.5%) stent thrombosis leading to MI and cardiac death were observed. The small subgroup of patients treated with IVL showed absence of significant procedural and clinical events, likely because of the short period of observation (5 months on average). Conclusion: This study confirms good clinical outcomes of both RA and IVL, with a high rate of procedural success and low incidence of TLR and MACE at long term, considering this subset of extremely complex patients and lesions. The results of the recently introduced IVL technology appear promising and combined treatment with RA followed by IVL appeared to be feasible and effective for the treatment of calcified coronary lesions.