Safety and efficacy of a novel calcified plaque modification device — Shockwave Intravascular Lithotripsy — in all-commers with Coronary Artery Disease: Mid-term outcomes

Background: Coronary interventions in calcified lesions are associated with a higher rate of clinical adverse events. Initial aggressive plaque modification along with post-implantation optimization is pivotal for achieving a favorable effect of the percutaneous coronary intervention (PCI). Recently, the Shockwave C2 Intravascular Lithotripsy (S-IVL), a novel acoustic wave-based device designed to modify calcified plaque, has been introduced into clinical practice. Aims: We evaluated the mid-term safety and efficiency of S-IVL in an all-comers cohort with severely calcified coronary lesions. Methods: We retrospectively analyzed a total 131 consecutive S-IVL PCI procedures. The study had two main inclusion criteria the presence of: calcified, resistant lesion (defined by an inadequate non-complaint balloon catheter inflation) or a significantly under-expanded stent (more than 20% of reference diameter). The study had two primary endpoints – successful clinical outcome and safety concerns. Clinical success was defined as effective stent deployment or optimization of a previously under-expanded stent (with less than <20% in-stent residual stenosis). Safety outcomes were defined as periprocedural complications, such as device failure, and major adverse cardiac and cerebrovascular events (MACCE). Clinical follow-up was performed at the end of hospitalization and 6 months after the index procedure. Results: In-hospital MACCE was 4.6% with 1.5% target lesion revascularization (TLR) and one case of subacute fatal stent thrombosis. At the 6-month-follow-up, the MACCE rate was 7.9% with a concomitant TLR rate of 3.8%. Conclusion: Our mid-term data confirm an acceptable safety and efficacy of intravascular lithotripsy as a valuable strategy for lesion preparation and stent optimization in an all-comers cohort with severely calcified coronary lesions

Multicenter registry of Impella-assisted high-risk percutaneous coronary interventions and cardiogenic shock in Poland (IMPELLA-PL)

Background: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021.Aims: We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries.Methods: IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge.Results: Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively.Conclusions: Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation

Changes in Cell Biology under the Influence of Low-Level Laser Therapy

Low-level laser therapy (LLLT) has become an important part of the therapeutic process in various diseases. However, despite the broad use of LLLT in everyday clinical practice, the full impact of LLLT on cell life processes has not been fully understood. This paper presents the current state of knowledge concerning the mechanisms of action of LLLT on cells. A better understanding of the molecular processes occurring within the cell after laser irradiation may result in introducing numerous novel clinical applications of LLLT and potentially increases the safety profile of this therapy