D-59 | Pooled Cardiovascular Outcomes With Combined Atherectomy and Intravascular Lithotripsy in Calcified Coronary Lesions

In patients undergoing percutaneous coronary intervention (PCI), severely calcified lesions present a therapeutic challenge. Few small studies have explored feasibility and safety of combined atherectomy and intravascular lithotripsy (IVL) for treatment of severely calcified coronary lesions. Online databases were searched for studies using combined atherectomy (rotational, orbital or excimer laser) and IVL during PCI of calcified coronary lesions. The outcomes of interest were procedural success, periprocedural complications and cardiovascular (CV) events. Pooled proportions with 95% confidence intervals (CI) were calculated using a random-effects model. A total of 9 observational studies with 309 patients were included. The mean age was 72 years and 77% were men. 49% of patients presented with stable angina and 51% had acute coronary syndrome. Pooled procedural success rate of combined atherectomy and IVL was 96% (95% CI 93.58 - 97.87) (figure), with vessel perforation occurring in 4.3% (95% CI 2.21 - 6.98). Over a mean follow up of 87 days, the incidence of CV outcomes was: myocardial infarction 2.1% (95% CI 0.75 - 4.19), stroke 0.4% (95% CI 0.00 - 1.69), target vessel revascularization 1.3% (95% CI 0.27 - 3.02), stent thrombosis 1.4% (95% CI 0.24 - 3.58), major bleeding 5.8% (95% CI 0.00 - 21.40), CV death 3.5% (95% CI 1.73 - 5.81) and all cause death 5.7% (95% CI 2.59 - 9.89). Combined atherectomy and IVL for calcified coronary lesions is feasible with high procedural success rate and low risk of periprocedural complications and adverse CV events.