Comparison of Procedural and Clinical Outcomes of Angiography- Versus Imaging-Guided Percutaneous Coronary Intervention With Intravascular Lithotripsy.

BACKGROUND

Intravascular lithotripsy (IVL) is an innovative treatment for coronary artery calcification (CAC).

AIMS: This study aimed to compare procedural and clinical outcomes of intracoronary imaging (ICI)-guided percutaneous coronary intervention (PCI) versus angiography-guided PCI with IVL in patients with CAC.

METHODS

A total of 509 patients were analyzed from the BENELUX-IVL registry (May 2019 to September 2024). Angiography-guided PCI with IVL was defined as therapy under solely fluoroscopic guidance. ICI-guided PCI with IVL was defined as PCI with IVL and concomitant use of ICI for procedural guidance either pre- and/or post-IVL. The primary endpoint was procedural success, defined as Thrombolysis In Myocardial Infarction (TIMI) 3 flow, residual stenosis < 30%, and absence of in-hospital major adverse cardiovascular events (MACE). Safety endpoints included procedural complications and MACE up to 2-year follow-up.

RESULTS

A total of 537 lesions were treated with IVL: 252 (46.9%) angiography-guided and 285 (53.1%) ICI-guided. The ICI-guided group had more complex lesions, with higher rates of aorto-ostial (20.2% vs. 30.9%; p = 0.005), chronic total occlusions (2.8% vs. 12.3%; p = 0.001), and long-segment lesions (58.7% vs. 69.5%; p = 0.009). Procedural success rates were comparable between groups (88.7% vs. 89.7%; p = 0.71), as were device success (97.9% vs. 97.4%; p = 0.72) and technical success (89.1% vs. 91.5%; p = 0.35). MACE rates remained similar at all time points up to 2-year follow-up (p > 0.05).

CONCLUSION

Procedural success was comparable between angiography-guided and ICI-guided PCI with IVL, despite greater lesion complexity in the ICI-guided group. Complication rates were similar, with no significant differences in MACE or mortality at long-term follow-up.