Early experience of intravascular lithotripsy in unprotected calcified left main coronary artery disease

Area of Science:

• Interventional Cardiology
• Cardiovascular Disease
• Medical Device Technology

Background:

• Treatment of unprotected severely calcified left main coronary artery (LMCA) disease presents significant interventional challenges.
• Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established treatments for coronary calcification outside the LMCA.
• This study evaluates the feasibility of IVL compared to RA in unprotected LMCA disease.

Purpose of the Study:

• To assess the feasibility and outcomes of intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for treating unprotected severely calcified left main coronary artery (LMCA) disease.
• To compare procedural success, angiographic success, and major adverse cardiac events (MACE) at one year between IVL and RA in LMCA disease.

Main Methods:

• Retrospective analysis of IVL and RA procedures for unprotected LMCA disease performed between January 2019 and April 2022.
• Evaluation of procedural and angiographic success (stent delivery with <50% residual stenosis, no complications).
• Assessment of one-year composite of major adverse cardiac events (MACE).

Main Results:

• Procedural and angiographic success rates were high (≥84%) across IVL and RA groups for LMCA and non-LMCA treatments.
• One-year MACE rates were comparable: 22.7% for LMCA IVL, 19.8% for LMCA RA, and 21.4% for non-LMCA IVL.
• IVL was predominantly used as a second-line or bailout technique in LMCA and non-LMCA calcified lesions.

Conclusions:

• Intravascular lithotripsy (IVL) is a feasible adjuvant calcium modification technique for unprotected calcified LMCA disease, often used as a second or third-line treatment.
• The safety and efficacy of IVL in this setting appear comparable to rotational atherectomy (RA).
• Larger randomized controlled trials are warranted to formalize the use of IVL in unprotected calcified LMCA disease.