Acute and short-term outcome of Intravascular Coronary Lithotripsy and Excimer Laser Coronary Atherectomy for Severe Stent Underexpansion: The Multicenter IVL-ELCA DRAGON Registry

Abstract

Background: Intravascular lithotripsy (IVL) and excimer laser-coronary atherectomy (ELCA) could be both used in the percutaneous treatment of coronary stent underexpansion. Aims: To investigate the effectiveness and safety of IVL vs. ELCA for the treatment of stent underexpansion related to heavy calcifications. Methods: Consecutive patients with severe stent underexpansion treated with IVL or ELCA with intravascular imaging assessment entered the multicenter IVL-ELCA Dragon Registry. The primary efficacy endpoint was device success defined as technical success with a final stent expansion ≥80%. Thirty days device-oriented composite endpoint consisting of cardiac death, target lesion revascularization or target vessel myocardial infarction was the secondary endpoint. Results: A total of 121 patients were enrolled, of which 69 (57%) underwent IVL and 52 (43%) ELCA. Baseline stent expansion was in IVL 35.4 (26.5–51.8) vs. 26.5 (24.2–31.8) in ELCA group. The most prevalent target vessel was the right coronary artery. Device success was similar in IVL vs. ELCA (76.8% vs. 75%; P = 0.82). Relative increase of stent expansion, were greater in the ELCA group (47.6 [30.9–63.6] vs. 58.0 [49.8–65.6]; P <0.001), however there were no differences in delta of minimum lumen area (5.1 [2.8-8.1] vs. 4.6 [3.9–5.8] mm2; P =0.34) and minimum stent area (5.1 [2.5] vs. 5.1 [1.1] mm2; P = 0.53) between pre and post PCI. At 30-day follow-up, there were no differences in device-oriented composite endpoint (2.9% vs. 3.8%; P = 0.77). Conclusions: In patients with underexpanded stents, both IVL and ELCA led to comparable device success and safety outcomes at short-term follow-up.