Intravascular Lithotripsy for Calcific Coronary Bifurcations: Procedural Success and 1-Year Clinical Outcomes

Intravascular lithotripsy (IVL) has emerged as a promising treatment for heavily calcified coronary lesions. However, evidence regarding its effectiveness in calcific bifurcation lesions remains limited.

We aimed to evaluate the technical success and 1-year clinical outcomes of IVL in calcified coronary bifurcation lesions.

Patients undergoing PCI with the use of IVL from the ongoing prospective BENELUX-IVL registry were included. Participants were stratified into bifurcation and non-bifurcation groups. The primary technical endpoint was technical success, defined as successful crossing of the IVL catheter across the target lesion with a residual stenosis of < 30%. The primary safety endpoint was in-hospital major adverse cardiac events (MACE).

Among 509 patients, 114 (22.4%) had coronary bifurcation lesions. Compared to the non-bifurcation group, the bifurcation group had higher SYNTAX scores (25 [18-33] vs. 18 [10-29]; p < 0.01), longer procedural times (100 [75-129] min vs. 78 [59-107] min; p < 0.01), and greater contrast volume use (208 ± 8 mL vs. 176 ± 4 mL; p < 0.01). Abrupt side branch occlusion (1.8%) and bail-out two-stent techniques (3.6%) were infrequent. IVL achieved comparable technical success (91.2% vs. 90.0%, p = 0.71) and 1-year MACE rates (9.6% vs. 5.8%, p = 0.20) in bifurcation versus non-bifurcation lesions.

IVL demonstrates excellent safety and efficacy in calcified coronary bifurcation PCI, achieving high technical success with low device-dependent adverse event rates.