Clinical and Procedural Outcomes of Image-Guided IVL in Calcified Coronary Lesions: A Retrospective Analysis

Abstract

Background: Imaging-guided coronary intervention by intravascular lithotripsy (IVL) for severe calcification is reported to be a feasible option. In this study, we reported our experience with intravascular lithotripsy for treating severe calcific lesions in both acute and chronic coronary syndromes, comparing procedural success and clinical outcomes.

Methods and results: This was a single-center, single-operator, retrospective study of all patients treated with image-guided intravascular lithotripsy (IVL) via a radial approach in Bangladesh from January 2022 to January 2024. Both ACS & CCS patients were included. Patient demographics, procedural variables for safety/efficacy, in hospital & 30-day outcomes were evaluated. The primary endpoints were an in-hospital major adverse cardiovascular event (MACE), including death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary endpoints were a clinical success: stent expansion with <30% in-stent residual stenosis & minimum stent area more than distal reference lumen area by imaging with no in-hospital MACE. During the study period, there were 50 patients (62% male; mean age 67.58±8.38 years) (53 coronary lesions) who underwent image-guided IVL through a radial approach. Among them, 27 (54%) patients presented with ACS & the rest of the patients presented with CCS. IVUS-guided IVL was done in 48 (96%) cases. Two cases (4%) were done by OCT. Procedural-related complications such as coronary dissection occurred in 10 (20%), side branch occlusion was 3 (6%) & slow flow was observed in 1(2%). Angiographic & Imaging success (<30% residual stenosis) occurred in 26 cases (96.3%) in the ACS group & 20 cases (87%) in the CCS group, with no significant difference between them. There was no MACE in-hospital & 30 days after follow-up.

Conclusions: Image-guided IVL is an effective and feasible strategy for calcium modification in both ACS & CCS groups of patients with high success rates and minimal procedural complications.