No Surgical Backup?
Updated SCAI guidance includes Coronary IVL as a treatment option in all U.S. cath labs regardless of surgical backup status.
SCAI has updated the 2014 Expert Consensus on PCI Without Surgical Backup with new guidance that includes Coronary IVL as a potential therapeutic option in all cath labs - including facilities without on-site surgical backup.1
As seen in the table below, SCAI's statement lists IVL as a therapy option across the four different surgical and non-surgical facility types. The updated guidance expands the number of hospitals that can access IVL to include sites where calcium modification tools were previously not recommended. The prior guidance, published in 2014, recommended to avoid the treatment of high-risk lesions defined as “more than moderate calcification” in facilities without surgical backup.2 Authors of the new guidance acknowledged the limitations of the previous guidance:
“…these [prior] recommendations may have restricted practice, limited patient choice, and exposed interventional cardiologists to legal risk. Such prohibitions have become outdated as the skill of interventional cardiologists and technological advances have expanded treatment options, outcomes data show no harm with PCI with no-SOS, and government policies actively encourage moving care to lower-cost areas. In particular, the prohibition of rotational and other atherectomy devices can paradoxically result in increased risk to the patient when balloon angioplasty is attempted in a calcified vessel.”
Operators and administrators working in non-surgical facilities interested in implementing Coronary IVL into their practice may be interested in reviewing the Cath Lab Digest article: Management of Calcified Lesions in Hospitals Without Surgical Backup.
Shockwave is proud to play a role in expanding care for patients in facilities without surgical backup through its demonstrably safe, effective and intuitive technology.
- 2. Dehmer GJ;Blankenship JC;Cilingiroglu M;Dwyer JG;Feldman DN;Gardner TJ;Grines CL;Singh M;. (n.d.). SCAI/ACC/AHA expert consensus document: 2014 update on percutaneous coronary intervention without on-site surgical backup. Retrieved January 30, 2023, from https://pubmed.ncbi.nlm.nih.gov/24637561/