Plaque modification in the 21st century – the first Hungarian experiences with intravascular lithoplasty

Osszefoglalo. A nagy mesztartalmu plakkok altal okozott szűkuletek percutan intervencioja az esetek egy reszeben a jelenleg szeles korben elerhető megoldasok alkalmazasaval technikailag nem kivitelezhető. A proceduralis sikertelenseg vezető oka a meszes laesiok kalciumtartalom miatti fokozott ellenallasa a ballonos dilataciokkal szemben, mely lehetetlenne teszi a szukseges sztentek levezeteset is. Az ilyen laesiok mesztartalmanak csokkenteset celzo hagyomanyos plakkmodifikacios eljarasok - mint a rotablatio, a vago- es ultranagy nyomasu ballonok - sem jelentenek megoldast minden esetben, kulonosen az erfal atmerőjenek legalabb 50%-at elerő, akar korkorosen jelen levő meszesedes fennallasa eseten. A kozelmultban eppen ezen laesiok mesztartalmanak feltordelesere, igy a sztentek deponalasanak elősegitesere kifejlesztett modszert a szakirodalom intravascularis lithoplastica neven emliti. A jelen kozlemenyben a Klinikankon eddig 4 beteg rendkivul meszes laesioinak jo angiologiai eredmenyű ellatasa soran az eszkozzel szerzett tapasztalatokat foglaljuk ossze. A vegeredmenyt tekintve az intravascularis lithoplastica igeretes uj intervencios lehetőseg a masszivan meszes coronarialaesiok ellatasara. Orv Hetil. 2021; 162(2): 69-73. Summary. Percutaneous intervention of stenoses caused by highly calcified plaques utilizing the currently widely available methods is not possible due to technical difficulties in several cases. Increased resistance of calcified plaques against balloon dilation due to their calcium content plays a leading role in procedural failure, as stent crossing becomes impossible as well. Classical methods of plaque modification for debulking the calcification of such lesions - such as rotablation, cutting and ultra-high pressure non-compliant balloons - do not resolve this issue, especially when calcification exceeds 50% of the vessel diameter. A new method, referred to as intravascular lithoplasty in the literature, has recently been developed to break the calcium and thus promote stent deployment in such lesions. In our current work, we summarize the experience gathered with this method during the treatment of extremely calcified lesions of 4 patients with good angiographic result. As a conclusion, intravascular lithoplasty is a promising new interventional method in the treatment of massively calcified coronary lesions. Orv Hetil. 2021; 162(2): 69-73.