35 Intravascular lithotripsy-assisted PCI for severe calcific coronary disease: evaluating the impact on quality of life and outcomes
Notice bibliographique
Résumé
Introduction Severe coronary artery calcification (CAC) in patients undergoing percutaneous coronary intervention (PCI) is a common cause of procedural complications, lack of success, and stent failure. In this study we examine the utility of a novel technique to deal with this problem: intravascular lithotripsy (IVL) using the ‘Shockwave’ device. Methods A retrospective single centre study was conducted of consecutive patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Procedural success was verified by independent review of the angiogram and defined as (1) adequate stent expansion, (2) no significant residual stenosis and (3) TIMI III flow in all major branches. Target lesion revascularisation (TLR) was defined as any unplanned repeat PCI of the target lesion or bypass of the target vessel performed for in-stent restenosis (ISR) or other complication of the target lesion. Clinical outcomes including Canadian Cardiovascular Society (CCS) angina classification were assessed at virtual clinical follow-up. Results 47 patients were treated with IVL during the study period. Baseline demographics and procedural characteristics are seen in tables 1 and 2, respectively. All patients had circumferential or near-circumferential calcium as determined by coronary angiography ± intracoronary imaging. 57% had treatment of a de novo lesion, 32% had PCI to a previously placed under-expanded stent and 11% had severely calcified ISR. Procedural success was high (94%), however, reasons for failure/abandonment included: (i) intra-procedural ischaemia with significant residual stenosis, (ii) prolonged procedural time, ischaemia and resistant stent under-expansion and (iii) prolonged procedural time, dissection with no-reflow, in the setting of a chronic total occlusion (CTO). Complications Included Coronary dissection (13%) of which the majority were successfully treated with conservative measures and coronary perforation (2%) which was treated with prolonged balloon inflation. At a mean follow up of 10 months, 23% underwent planned/staged-PCI, 4% underwent CABG and there were 2 (4%) deaths. There was a 51% reduction in CCS angina class from 2.9 (prior to IVL) to 1.4 (post IVL), p<0.00001. Conclusions The use of coronary IVL is a very effective percutaneous therapy for severe CAC. This cohort shows high procedural success with IVL and a significant reduction in CCS angina class at follow-up.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».