Shockwave intravascular lithotripsy facilitated percutaneous coronary intervention in patients with calcified coronary artery disease: a systematic review and meta-analysis of observational studies

Abstract Background Percutaneous coronary intervention (PCI) outcomes for patients with significant artery calcification (CAC) have been consistently inferior compared to without CAC. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option lesion modification of severely calcified plaques but supporting evidence on safety and efficacy this technology is narrow. The aim study assess S-IVL in severe CAC undergoing PCI. Methods We systematically searched MEDLINE, ClinicalTrials.gov the Cochrane Library identify studies assessing adult disease excluded those effect under-expanded stents and/or in-stent restenosis. Results largest meta-analysis date was performed. All were observational since no relevant randomized controlled trials published so far. Nine included our qualitative synthesis, while 7 them, total 794 enrolled patients, used quantitative synthesis. Frequency peri-procedural interest low: a) dissection: 2.52%, b) perforation: 3.0%, c) MI: 3.51%. Relative frequency 1-month MACE 5.59% cardiovascular death 1.01%. resulted increase post-IVL minimum lumen diameter by 1.67 mm, decrease vessel stenosis 53.60%, acute gain 1.68 mm. OCT analysis confirmed area 19.71% calcium angle 22.14o 1.62 mm2, however affecting maximum thickness. When we post-stent vs. pre-stent results, demonstrated further 35.89% 20.33o, 2.74 mm2 neutral Conclusion lithotripsy improvement facilitate stent delivery deployment arteries. Although appears be associated low incidence complications based present findings, from RCTs longer-term follow-up required advocate its routine use Funding Acknowledgement Type funding sources: None.