Intravascular lithotripsy in small coronary arteries: procedural and clinical outcomes from BENELUX-IVL registry

Abstract Background Coronary artery calcification (CAC) is common in patients undergoing percutaneous coronary intervention (PCI) and is associated with adverse outcomes. Intravascular lithotripsy (IVL) modifies both superficial and deep calcium, facilitating optimal stent expansion. Evidence regarding its use in small vessel disease (SVD) is limited. Methods This retrospective analysis of BENELUX-IVL multicenter registry included 454 patients (18 years) who underwent PCI with IVL for CAC across seven centres in two European countries between May 2019 and February 2024. From this, we selected 29 cases with SVD, defined by a reference vessel diameter (RVD) 2.5-2.75 mm. Quantitative coronary analysis (QCA) and intracoronary imaging were used to assess procedural and technical success. The primary endpoint was procedural success, defined as residual stenosis 30%, TIMI 3 flow and absence of in-hospital major adverse cardiovascular events (MACE). A safety endpoint was defined based on the occurrence of procedural complications and specific complications regarding the use of IVL. Results A total of 31 lesions (mean patient age 73.4±8.3 years, 72% male) were analysed. Device success was 100%, procedural success 86.2%, and no complications were recorded. QCA showed significant improvement in minimal luminal diameter, luminal area, diameter stenosis and area stenosis after IVL. At one-year follow-up, no MACE were observed and all-cause mortality was 3.7%. Conclusion IVL in calcified SVD appears to be safe and effective, with high success rates, favourable luminal gain and excellent clinical outcomes at 1 year.IVL usage in a small, calcified LADFor image description, please refer to the figure legend and surrounding text.