Intravascular lithotripsy to treat calcified coronary arteries during percutaneous coronary intervention

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 14 sources, which was discussed by the committee. The evidence included is based on about 8,300 people from 2 systematic reviews and meta-analyses, 1 small randomised controlled trial, 2 pooled analyses of prospective studies, 5 prospective studies, 2 retrospective cohort studies and 2 case reports. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: improved quality of life, reduced major cardiovascular events and coronary artery patency.

The professional experts and the committee considered the key safety outcomes to be: potential risk of coronary rupture and myocardial infarction.

Patient commentary was sought but none was received.

The committee noted that:

• the incidence of coronary artery calcification in people having percutaneous coronary intervention is increasing

• the importance of calcification is more recognised

• CT coronary angiography may show the presence of calcification so intravascular lithotripsy can be planned beforehand if the percutaneous coronary intervention is being done electively

• the number of procedures recorded in the National Institute for Cardiovascular Outcomes Research (NICOR) database has increased rapidly over the past few years.

The committee was informed that:

• there is more research being done on using intravascular lithotripsy for eccentric calcified lesions

• this procedure may result in less distal embolisation than other procedures used to manage calcification.