Clinical Conversation: Coronary Compliance Modification by Intravascular Lithotripsy: New Predictor of Stent Expansion in Calcified Coronary Lesions-Coronary Artery Compliance Modification by Intravascular Lithotripsy: A New Predictor of Stent Expansion in Heavily Calcified Coronary Lesions

Coronary Artery Compliance Modification by Intravascular Lithotripsy: A New Predictor of Stent Expansion in Heavily Calcified Coronary Lesions

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Video Summary

This discussion centers on a study published in J-SKY titled "Coronary Artery Compliance Modification by Intravascular Erythrotripsy," exploring how intravascular lithotripsy (IVL) affects arterial compliance in calcified coronary lesions and predicts stent expansion. Coronary artery compliance—the artery's ability to expand and contract—was measured invasively using intravascular ultrasound (IVUS) before and after IVL. The study found significant increases in compliance following IVL, especially in lesions exhibiting calcium fractures, which correlated with better stent expansion.<br /><br />Experts noted limitations such as lack of image co-registration and challenges in detecting all calcium fractures, highlighting the need for improved imaging methods. While calcium fractures confirm readiness for stenting, their absence doesn’t rule it out; angiographic signs like wire centralization and equal contrast provide complementary assessment. Thickness of calcification strongly influences fracture formation and compliance change.<br /><br />They discussed practical aspects of PCI, including optimal balloon inflation times to maximize vessel expansion and ways to balance adequate lesion preparation against risks of overtreatment. Future directions include developing real-time compliance sensors ("intelligent balloons") to guide interventions more precisely. Overall, the study introduces a novel compliance metric post-IVL, which could help optimize stent expansion while minimizing complications in managing calcified coronary lesions.

Keywords

Intravascular Lithotripsy

Coronary Artery Compliance

Calcified Coronary Lesions

Calcium Fractures

Stent Expansion

Intravascular Ultrasound

Percutaneous Coronary Intervention