Treatment of calcified coronary lesions with intravascular lithotripsy: experience of a regional French centre.

Abstract

Introduction: Coronary intravascular lithotripsy (CIVL) has emerged as a promising technique for modifying severe coronary calcification before stent deployment, yet real-world data are still limited. The present study aimed to evaluate the indications, procedural modalities, and clinical outcomes of CIVL in consecutive real-world patients.

Patients and methods: We conducted a retrospective analysis of all patients in whom CIVL was attempted between April 2022 and December 2023 at our centre, representing our initial experience with this technique. Demographic, clinical, and procedural data were extracted from electronic medical records. Follow-up data were obtained via telephone contact in patients who survived the index hospitalization without major complications.

Results: Seventy patients (mean age 76.9±9.3 years, 78.6% male) with one lesion per patient were included. The most frequent cardiovascular risk factor was hypertension (65.7%). 52.9% of patients presented with acute coronary syndromes; and 25% with chronic coronary syndromes. The mean procedural time was 65.6±28.1minutes, fluoroscopy time 25.7±13.6minutes, and contrast volume 170.3±71.6mL. The left anterior descending artery (44.3%) and right coronary artery (34.3%) were most commonly treated. Proximal lesions constituted 42.9% of the cohort. The mean lithotripsy balloon diameter was 3.3±0.5mm; mean stent diameter 3.4±0.5mm; average number of stents per lesion 1.5±0.7; and total stent length 34.6±18.6mm. In 8.3% of cases, CIVL was used as a bailout strategy for stent underexpansion. Angiographic success was achieved in 92.9% of procedures; one case (1.4%) resulted in coronary perforation. In 5.7% of lesions, the operator could not cross the lesion with the balloon; 2.9% required adjunctive rotational atherectomy. Over follow-up, cardiovascular death occurred in 7.1%, with no documented myocardial infarction, stroke, or target vessel revascularization.

Conclusion: In an older, comorbid population, CIVL appears to be an effective and safe strategy for treating heavily calcified coronary lesions, with a high angiographic success rate and acceptable complications. Our findings demonstrate that CIVL can be rapidly and safely integrated into the routine clinical workflow of a regional center, even in patients presenting with acute coronary syndrome.