Advances in Interventional Cardiology
eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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abstract:
Original paper

Intravascular lithotripsy for calcified left main coronary artery disease: procedural outcomes and two-year clinical follow-up

Wojciech J. Skorupski
1
,
Marek Grygier
1
,
Maciej Lesiak
1
,
Aleksander Araszkiewicz
1
,
Włodzimierz Skorupski
1
,
Przemysław Mitkowski
1
,
Małgorzata Pyda
1
,
Karolina Kochanowska
2
,
Aleksandra Grzelak
2
,
Marta Kałużna-Oleksy
1

  1. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
  2. Poznan University of Medical Sciences, Poznan, Poland
Adv Interv Cardiol
DOI: https://doi.org/10.5114/aic.2025.156680
Online publish date: 2025/12/03
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Introduction
Intravascular lithotripsy (IVL) has a strong safety and efficacy profile for managing calcified coronary lesions during percutaneous coronary intervention (PCI). Nevertheless, evidence on its application in left main (LM) disease remains scarce.

Aim
This study aimed to evaluate procedural success, efficacy, safety, and two-year clinical outcomes of IVL in LM PCI.

Material and methods
The analysis included 53 patients who underwent LM PCI using the Shockwave C2 and C2+ IVL systems beginning in April 2020. Outcomes were compared with those of 148 patients who underwent non-LM PCI during the same period.

Results
The two groups were similar in age. Non-ST elevation myocardial infarction (NSTEMI) (43.4% vs. 23.6%; p = 0.006) and heart failure history were more common in the LM cohort (47.2% vs. 29.1%; p = 0.017). Larger IVL balloon diameters were chosen in LM lesions, with less use of 3.0 mm balloons (24.5% vs. 44.6%; p = 0.016) and more use of 4.0 mm balloons (15.1% vs. 2.0%; p < 0.001). Intravascular imaging (IVUS/OCT) was performed in nearly every LM case (94.3% vs. 40.5%; p < 0.001). IVL success rates were high in both groups (100% vs. 96.6%; p = 0.400), as were overall procedural success rates. No cases of coronary artery perforation or slow-flow/no-reflow phenomena were recorded. During long-term follow-up, there were no differences between the LM and non-LM cohorts in all-cause mortality (14.8% vs. 6.3%; p = 0.087) or major adverse cardiovascular events (MACE) incidence (6.7% vs. 9.0%; p = 0.582).

Conclusions
In LM PCI, IVL demonstrates a favorable safety and efficacy profile, achieving high technical success rates and long-term outcomes, including MACE rates comparable to those observed in non-LM PCI.

keywords:

percutaneous coronary intervention, left main, intravascular lithotripsy
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