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

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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]mm 2 ; P =0.34) and minimum stent area (5.1 [2.5] vs. 5.1 [1.1] mm 2 ; 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.Key words: calcifications, ELCA, IVL, stent underexpansion the treatment of stent underexpansion.Thus, no specific recommendations regarding the preferred technique for treatment of stent underexpansion can be made.Herein, this multicentre IVL-ELCA-Dragon Registry aims to assess efficacy and safety outcomes of IVL and ELCA in the treatment of stent underexpansion.

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