BACKGROUND: Even if pilot studies have been conducted to validate Intravascular Lithotripsy, most challenging cases were excluded, including unprotected Left Main (LM) coronary stenosis.
METHODS: We retrospectively enrolled patients treated with IVL in a real-world multicenter registry from 21 centers among Italy and Spain from January 2020 to November 2021. The primary safety endpoint was freedom from major adverse cardiovascular events (cardiac death, target vessel revascularization, stent thrombosis) at 30 days. The primary effectiveness endpoint was procedural success (defined as stent delivery with a residual stenosis <20% and without intra-procedural MACE). Secondary endpoint were 6-months and 12-months MACE rates.
RESULTS: From a total amount of 470 patients enrolled in our registry, 41 underwent IVL to LM stenosis. Most of them were males (78.0%). The clinical presentation was acute coronary syndrome (ACS) in 41.4% of cases. Mechanical circulatory support was necessary in 4 cases (9.7%). IVL before stent implantation was planned in 90% of cases. The primary safety endpoint occurred in 97.6%. of patients. The primary effectiveness endpoint was achieved in 97.6% of cases. Interestingly, at 6 months and 12 months, no MACE was recorded.
CONCLUSIONS: Intravascular lithotripsy for the treatment of severely calcified Left Main stenosis seems to be a safe and effective option with very high procedural success rate and low MACE rate at follow-up.