Intravascular lithotripsy in calcified left main coronary artery: Procedural success and 1-year clinical outcomes.

Background: Intravascular lithotripsy (IVL) has an excellent efficacy and safety profile in the treatment of calcified coronary lesions during percutaneous coronary intervention (PCI). However, data regarding its use on left main (LM) lesions are still limited.

Objective: We aimed to analyze the technical success and 1-year clinical outcomes in calcified LM lesions treated with IVL.

Methods: Patients who underwent IVL from the ongoing prospective BENELUX registry were eligible for inclusion. Patients were divided into LM and non-LM groups based on the anatomical application of the IVL pulses. The primary technical endpoint was technical success, defined as the successful delivery of the IVL catheter across the target lesion, administration of IVL pulses without angiographic complications, and achieving a residual target lesion stenosis of less than 30 %. The primary safety endpoint was in-hospital major adverse cardiac events (MACE).

Results: The study included 509 patients (59 LM and 450 non-LM). Patients in the LM group were significantly older (79 years [75-82] vs. 73 years [68-81], p < 0.01). Left ventricular ejection fraction was slightly lower in the LM group (41 % [19-50] vs. 51 % [40-60], p = 0.053). Temporary mechanical circulatory support devices were more frequently used in the LM group, primarily as part of the "protected PCI" strategy (6.8 % in LM vs. 2.1 % in non-LM, p = 0.04). Technical success was comparable between the two groups (93.2 % in LM vs. 89.8 % in non-LM, p = 0.41). Cardiac death, MACE, and target vessel revascularization rates were also comparable at hospital discharge, 30 days, and 1-year follow-up.

Conclusion: IVL in calcified LM lesions achieved comparable technical success and long-term clinical outcomes to non-LM lesions.