Efficacy and safety of intravascular ultrasound-guided percutaneous coronary intervention with intravascular lithotripsy for severe calcified lesions.

Previous studies have demonstrated favorable outcomes with percutaneous coronary intervention (PCI) using initial intravascular lithotripsy (IVL) for calcified lesions. However, IVL outcomes under intravascular ultrasound (IVUS) guidance remain unclear. The aim of this study was to evaluate the initial clinical outcomes of PCI for severe calcified lesions using IVUS. In this study, we evaluated initial clinical outcomes of IVUS-guided PCI with IVL for severe calcified lesions. Consecutive IVL cases performed at our hospital between April and October 2023 were retrospectively analyzed. Primary outcomes included cross-sectional area (CSA, mm2) and percent area stenosis (%AS) at the pre-IVL minimum lumen area (MLA) site as measured by IVUS. Pre-IVL, post-IVL, and post-stent results were compared. Secondary outcomes included angiographic success, procedural complications, and major adverse cardiovascular events (MACE) within 1 year. Thirty-one patients with 32 lesions were included. CSA values at the pre-IVL MLA site were 2.2 ± 0.9, 4.2 ± 1.5, and 7.5 ± 2.3 mm2, and %AS values were 80.1 ± 7.2%, 62.9 ± 12.3%, and 35.5 ± 16.3% (p < 0.001). Angiographic success was achieved in all cases without complications. At 1 year, the cumulative MACE rate was 9.6%, comprising cardiac death (3.2%), myocardial infarction (3.2%), and target vessel revascularization (3.2%). IVUS-guided PCI with IVL for severe calcified lesions demonstrated high procedural success, no complications, and low 1-year MACE rates, highlighting the safety, effectiveness, and clinical relevance of IVUS guidance in real-world practice.