Intravascular Lithotripsy-Enhanced Treatment of Paravisceral Coral Reef Aorta

Background: Coral reef aorta (CRA) is a rare and therapeutically challenging condition characterized by heavily calcified paravisceral aortic stenosis, leading to severe clinical manifestations. Open surgery is associated with substantial perioperative morbidity and mortality, while standard endovascular approaches often face technical limitations. This multicentre study aimed to evaluate the feasibility and safety of intravascular lithotripsy (IVL) combined with aortic and/or reno-visceral vessel (RVV) stenting for the treatment of paravisceral CRA. Patients and methods: Patients with paravisceral CRA treated with IVL between 2021 and 2025 across six vascular centres were retrospectively analysed. The primary endpoint was technical success. Secondary endpoints included IVL-related complications, perioperative mortality, freedom from reintervention, clinical improvement, and aortic lumen gain at the site of maximum stenosis. Results: A total of 16 patients were included. Presenting symptoms were claudication (n=15), renal failure (n=9), mesenteric ischemia (n=4), and cardiac failure (n=2). IVL alone was performed in 3 patients (18.8%), while 13 patients (81.2%) underwent adjunctive aortic and/or RVV stenting. Technical success was achieved in all cases. There were no IVL-related complications or perioperative deaths. All patients demonstrated clinical improvement and significant aortic lumen gain. During a median follow-up of 5 (1-11.5) months, two elective reinterventions were required. No patients were lost to follow-up. Conclusions: In our cohort, IVL combined with aortic and/or RVV stenting appeared to be a feasible and safe endovascular strategy for the management of paravisceral CRA. The approach offers high technical success with low perioperative morbidity, mortality, and reintervention rates.