Intravascular lithotripsy (IVL) has emerged as a novel modality for treatment of highly-calcified
coronary lesions. However, real-world data regarding the efficacy and safety of IVL
are lacking, particularly for high-risk or complicated coronary lesions. We conducted
a study to determine real-world outcomes of IVL in a high-risk population.
METHODS AND RESULTS
A retrospective review of consecutive patients who underwent IVL at a tertiary care
center between Sep 1, 2019 and Jan 31, 2021 was undertaken. A comprehensive electronic
medical record and centralized cardiac catheterization database were used to ascertain
clinical and procedural characteristics and outcomes of the patients. The primary
outcome was major adverse cardiac events (MACE), defined as death, myocardial infarction,
or unplanned target vessel revascularization. Secondary outcomes included angiographic
success and freedom from angina. 50 patients, totalling 64 lesions, underwent IVL
during the study period. 3 patients suffered in-hospital mortality unrelated to the
IVL; there was no other occurrence of MACE in hospital or at 30 days. Angiographic
success was near universal (98% of patients with residual stenosis < 50%, and 96%
of patients with TIMI 3 flow) and periprocedural complication was very rare. Among
patients undergoing IVL of in-stent restenosis (ISR) (n=13) or left main coronary
artery (LMCA) (n=12) lesions, angiographic success was universal and there was no
occurrence of periprocedural complication or 30-day MACE.
In a high-risk real-world cohort, including patients with acute coronary syndrome
and those undergoing PCI of the LMCA and ISR lesions, IVL was a highly safe and effective
treatment for highly-calcified coronary lesions.