Clinical Outcomes of Intravascular Lithotripsy for Severely Calcified Coronary Lesions: A Single-Center Study.

BACKGROUND

Intravascular lithotripsy (IVL) is an emerging calcium modification technique designed to optimize stent expansion in patients with severely calcified coronary artery disease. While clinical trials support its efficacy, real-world data from Asia remain limited.

OBJECTIVES

To evaluate the procedural success, safety, and 1-year clinical outcomes of IVL in a single-center Taiwanese cohort.

METHODS

This retrospective single-center cohort study enrolled patients undergoing IVL for complex calcified coronary lesions between November 2022 and October 2024.

RESULTS

The 1-year MACE rate was 13.6% (raw proportion), driven by cardiac death (1.5%), myocardial infarction (4.5%), ischemia-driven target vessel revascularization (7.6%), and prior in-stent restenosis requiring repeat revascularization (3.0%). The Kaplan-Meier-estimated 1-year cumulative incidence of MACEs was 14.9%. Subgroup analyses showed significantly higher MACE and revascularization rates in patients with end-stage renal disease (ESRD) (p = 0.004, 0.012) and in non-bifurcation lesions (p = 0.014). Multivariable analysis identified ESRD as an independent predictor of MACEs (hazard ratio [HR]: 5.790, p = 0.004) and revascularization (HR: 7.233, p = 0.015); stent under-expansion was also independently associated with revascularization (HR: 7.030, p = 0.010). These findings highlight the clinical performance of IVL and key predictors of adverse outcomes.

CONCLUSIONS

IVL appears to be safe and effective for managing complex calcified coronary lesions. Outcomes in this study were influenced by renal dysfunction and stent expansion.