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.