We would like to thank the authors for their insightful and constructive comments regarding our manuscript. We appreciate the opportunity to clarify several important methodological and interpretative aspects of our study.

We fully acknowledge the conceptual concern that direct comparison between left main (LM) and non-LM intravascular lithotripsy (IVL) procedures may involve inherently different anatomical, procedural, and prognostic contexts. Our intention was not to imply procedural equivalence between these groups [1].

Although our cohort represents one of the larger real-world datasets reported to date in this specific setting, the study was not originally designed or powered to assess long-term clinical endpoints or to formally compare LM versus non-LM outcomes [1]. Rather, it reflects a prospective analysis of consecutive patients undergoing percuntaneous coronary intervention (PCI) with Shockwave C2 and C2+ IVL in a high-volume tertiary center. The inclusion of the non-LM cohort was intended to provide a broader clinical context and to situate LM IVL outcomes within contemporary daily practice. At the same time, we agree that these groups are inherently heterogeneous, as also reflected by differences in baseline characteristics, anatomical complexity (e.g., higher SYNTAX score), and procedural features in the LM cohort. This heterogeneity may have influenced the observed outcomes.

We appreciate the authors’ comment regarding the numerically higher 2-year all-cause mortality in the LM group (14.8% vs. 6.3%). We fully agree that the absence of statistical significance (p = 0.087) should not be interpreted as evidence of equivalence. Importantly, our study was not designed as a non-inferiority or equivalence trial, and the sample size – although relatively large for this clinical niche – remains insufficient for definitive comparisons of long-term clinical endpoints. The limited number of events further restricts statistical power.

We...


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