D-50 | Use of intravascular lithotripsy for management of coronary in-stent restenosis, outcomes from single center study

Management of in-stent restenosis (ISR) secondary to calcific neo-atherosclerosis or inadequate stent expansion due to calcified plaque behind the stent struts remains a challenge. IVL (intravascular lithotripsy) can modify the plaque behind the stent thereby facilitating optimal stent expansion and lumen again. We aim to assess the effectiveness of IVL in achieving optimal Minimal Luminal Area (MLA) by IVUS in patients with ISR and 30-day cardiovascular events. This is a single-center retrospective study. All patients with calcific ISR (calcific plaque behind the stent struts) who did not achieve optimal MLA despite non-compliant balloon/cutting/scoring balloon, IVL was utilized for plaque modification. MLA was measured post IVL. Primary outcome was to achieve optimal MLA (defined as at least 80% of native vessel or gain in MLA of 1-2mm2), secondary outcomes were readmission for ACS, major bleeding, and target lesion revascularization. 20 patients underwent atherectomy with IVL for ISR. Baseline characteristics are presented in the table. Left main (LM), LAD, RCA, and Circumflex (Cx) were culprit vessel in 5, 60, 10, 25% of cases respectively. MLA before IVL use was 4.7, 3.23±0.41, 3.5 and 3.3±0.15 respectively in LM, LAD, Cx, and RCA. After IVL, MLA doubled in all 3 vessels. Mean follow up was 3.6 months, two patients were re-admitted with GI bleed, while one patient was readmitted with angina and required revascularization. IVL allows for plaque modification behind the existing stents which allows for optimal stent expansion with optimal MLA. Further, larger studies are needed to validate the results.