INTRAVASCULAR LITHOTRIPSY (IVL) achieved encouraging stent expansion in patients undergoing treatment for severely calcified left main coronary disease, according to a prospective study conducted across five UK centres.
The findings support further investigation of IVL alongside intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in this challenging setting.
The left main coronary artery supplies a large proportion of the heart muscle. Treating narrowing at its distal end can be particularly complex because this is where the artery divides into two major branches.
Heavy calcium deposits make the artery less flexible and can prevent a stent from expanding adequately. IVL delivers acoustic pressure pulses through a balloon catheter to fracture calcium within the artery wall, helping prepare the vessel for stent implantation. However, prospective evidence specifically examining its use in calcified left main disease has been limited.
Researchers enrolled 50 patients undergoing PCI for calcified distal left main disease or closely related narrowing at the origins of its branches. Participants had a mean age of 77 years; 60% had diabetes and 42% had chronic kidney disease.
A heart team assessed patients as suitable for PCI, and IVUS confirmed extensive calcification before treatment. Ultrasound imaging was required before IVL, after calcium modification, and following stent implantation. The procedure also incorporated mandatory stent optimisation.
The study assessed whether the IVL device could reach the lesion, how well the implanted stents expanded, and subsequent clinical outcomes.
The IVL device successfully crossed the target lesion in all 50 patients, with no reported device malfunctions. The average minimum stent area in the left main artery was 13.36 mm². Among the 49 patients with analysable imaging, 84% achieved an area exceeding the study’s 11 mm² target.
There were no deaths or myocardial infarctions during the procedural period. However, one patient experienced a postprocedural stroke and another had bleeding requiring transfusion.
No major adverse cardiac events occurred within 30 days. This composite outcome included cardiac death, myocardial infarction, and repeat treatment of the target vessel; it did not include stroke or bleeding. At 12 months, four patients had experienced major adverse cardiac events, and no stent thrombosis was reported.
Visible calcium fractures on IVUS were not associated with final stent expansion. This suggests that the absence of an obvious fracture on imaging may not reliably indicate an inadequate treatment response.
The findings are promising, but the study was small and had no comparison group. Patients whose lesions were considered to require atherectomy or specialist balloons were excluded, limiting applicability to more complex cases.
The results also reflect IVL combined with ultrasound guidance and careful stent optimisation. Larger comparative studies are needed to establish how this approach performs against other calcium-modification strategies and whether the mechanical results translate into lasting clinical benefits.
Reference
Cosgrove CS et al. Intravascular lithotripsy in left main stem percutaneous coronary intervention. Catheter Cardiovasc Interv. 2026;DOI:10.1002/ccd.70927.
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