Primary percutaneous coronary intervention is now being performed in older and more co-morbid patients, with more calcified and complex coronary disease. Coronary artery calcium is frequent in culprit lesions in ST-elevation myocardial infarction (STEMI), and is a major risk factor for stent underexpansion and subsequent stent failure. Existing calcium modification tools such as high pressure balloons or atherectomy have limitations for their use in STEMI PCI due to concerns about worsening coronary flow via distal clot embolisation. Coronary intravascular lithotripsy (IVL) is a relatively new calcium modification tool and offers several potential advantages in STEMI PCI, including its shorter learning curve and reduced risk of complications owing to its design as a balloon-based therapy. While a few retrospective case series have reported safety of IVL in STEMI, there have been no randomised trials comparing effectiveness and safety of IVL with existing calcium modification tools in STEMI PCI.
Last updated17 January 2023