Key result
IVL yields similar 12-month MACE rates in concentric versus eccentric calcified lesions.
Why the study?
Specific focus on different coronary calcification patterns treated with intravascular lithotripsy (IVL) remains limited, necessitating evaluation of procedural and clinical outcomes in concentric versus eccentric calcifications.
Does intravascular lithotripsy (IVL) yield different procedural and clinical outcomes in concentric versus eccentric coronary calcifications?
Observational (n=136)
Yes
Does intravascular lithotripsy (IVL) yield different procedural and clinical outcomes in concentric versus eccentric coronary calcifications?
Absolute Event Rate: 6.2% vs 4.3%
p-value: p=0.66
Intravascular lithotripsy demonstrates similarly high technical success and low 12-month adverse event rates in both concentric and eccentric coronary calcifications.
Supports IVL across calcification patterns; leaves open randomized confirmation of equivalence.
BACKGROUND: Intravascular lithotripsy (IVL) has demonstrated excellent results in treating calcified coronary lesions. However, specific focus on different calcification patterns is still limited. The aim of our study was to evaluate the procedural and clinical outcomes of IVL in treating concentric vs. eccentric calcifications. METHODS: The BENELUX-IVL prospective registry enrolled patients aged ≥18 years who underwent IVL. For this study, patients who underwent both IVL and intravascular ultrasound (IVUS) before and after the procedure were selected. Based on IVUS-derived calcium arc quantification, patients were categorized into two groups: concentric calcification (>180°) and eccentric calcification (≤180°). The primary technical endpoint was technical success, defined as successful IVL catheter crossing of the target lesion with residual stenosis <30%, with final TIMI 3 flow. The primary efficacy endpoint was the incidence of major adverse cardiac events (MACE) at 12-month follow-up. RESULTS: A total of 455 patients were enrolled in the registry, of whom 136 (29.9%) met the inclusion criteria for the study. Concentric calcifications were more prevalent (83.1% vs. 16.9%, P < 0.01). The median SYNTAX score was similar between the two groups [19 (10-29) vs. 20 (12-31), P = 0.64]. Technical success was achieved similarly between the two calcification patterns (93.0% vs. 95.7%, P = 0.98). At 12-month follow-up, MACE (6.2% vs. 4.3%, P = 0.66), cardiac death (1.8% vs. 4.3%, P = 0.44), and target vessel revascularization (4.4% vs. 4.3%, P = 0.99) were similar. CONCLUSION: IVUS-guided percutaneous coronary intervention of calcified lesions treated with IVL demonstrates comparable procedural outcomes and low adverse clinical event rates in both concentric and eccentric calcification patterns. However, further studies are warranted to draw definitive conclusions regarding long-term clinical outcomes.
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Oliveri et al. (2025) conducted an observational in Calcified coronary lesions (n=136). Concentric calcification (>180°) vs. Eccentric calcification (≤180°) was evaluated on Incidence of major adverse cardiac events (MACE) at 12-month follow-up (p=0.66). Intravascular lithotripsy for calcified coronary lesions yielded similar 12-month major adverse cardiac event rates in concentric versus eccentric calcifications (6.2% vs 4.3%, P=0.66).
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