Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis

Abstract

Background

Intravascular lithotripsy (IVL) has emerged as a novel technology for modifying calcified coronary lesions, whereas optical coherence tomography (OCT) enables high-resolution assessment of calcium modification and procedural outcomes. However, the mechanistic and procedural effects of IVL assessed by OCT across studies remain incompletely characterized.

Methods

A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261332946). PubMed/MEDLINE, Cochrane Library, and Epistemonikos were searched from inception through February 2026. Randomized controlled trials and observational studies with extractable quantitative OCT outcomes were included. The primary endpoint was OCT-detected calcium fracture. Secondary endpoints included multiple calcium fractures, minimum stent area (MSA), stent expansion, acute lumen gain, procedural success, and in-hospital major adverse cardiovascular events (MACEs). Random-effects meta-analyses were performed to estimate pooled proportions or mean values with 95% confidence intervals (CIs).

Results

Thirty studies encompassing a total of 3030 patients were included. OCT-detected calcium fracture occurred in 68% (95% CI 56%-79%) of lesions, whereas multiple fractures were observed in 34% (95% CI 26%-41%). IVL-treated lesions achieved favorable procedural metrics, including a pooled final MSA of 6.45 (95% CI 6.07-6.82) mm², stent expansion of 85.9% (95% CI 82.3%-89.5%), and acute lumen gain of 3.50 (95% CI 3.14-3.87) mm². Procedural success was high (95%, 95% CI 93%-98%) with low in-hospital MACEs (2%, 95% CI 1%-3%). Substantial heterogeneity was observed across endpoints.

Conclusions

Coronary IVL assessed by OCT is frequently associated with calcium fracture and favorable procedural outcomes with high procedural success and low early adverse events.