Intravascular lithotripsy (IVL) facilitates drug-coated balloon (DCB) delivery and leads to favorable results in severely calcified coronary lesions without stenting.

BACKGROUND

Coronary artery disease, especially in the elderly population, can lead to calcification of the arteries, which is tightly connected to an unfavorable prognosis. We investigated the combination of coronary intravascular lithotripsy (IVL) to ease deliverability of drug-coated balloons (DCBs) with the potential favorable effect of DCB in avoiding vessel thrombosis due to lack of foreign body implantation.

METHODS

Seventy-three calcified lesions were studied in an open, observational, prospective, single-arm consecutive registry. The role of IVL was studied as to the facilitation of DCB delivery, procedural, angiographic, and clinical outcomes. DCB only angioplasty without stenting was possible in 55 (75%) of these lesions after successful treatment with IVL for the analysis of procedural and long-term outcomes, while 35 patients had 4 months follow-up quantitative angiography to study angiographic success.

RESULTS

Despite the severe calcifications, the DCB could be advanced in time in all cases: delivery was easy and without any (n = 43), with minimal resistance (n = 6), and some friction (n = 6), and the average delivery time was 30.9 s. Angiographic follow-up at 4 months revealed only 1 binary restenosis and no increase in percent stenosis (26%). Average late lumen gain was 0.04 mm (95%CI =  - 0.15 mm; 0.07 mm). 30.3% of the lesions showed a negative in-lesion late loss, i.e., a late lumen gain of ≥ 0.20 mm.

CONCLUSION

Lesion preparation of severely calcified coronary stenoses with IVL greatly facilitates DCB delivery. Like non-calcified lesions, the calcified lesions treated did not show significant late lumen loss and a tendency towards late lumen gain.