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Multicenter Study
. 2025 Sep-Oct:73:108-113.
doi: 10.1016/j.hrtlng.2025.04.030. Epub 2025 May 12.

Intravascular lithotripsy and temporary mechanical circulatory support for the treatment of heavily calcified coronary artery disease: insights from the BENELUX-IVL registry

Federico Oliveri  1 , Isabel Merino  2 , Martjn J H van Oort  3 , Ibtihal Al Amri  3 , Brian O Bingen  3 , Fatih Arslan  3 , Bimmer E Claessen  4 , Aukelien C Dimitriu-Leen  5 , Joelle Kefer  6 , Hany Girgis  7 , Tessel Vossenberg  8 , Frank van der Kley  3 , J Wouter Jukema  9 , Josè Montero-Cabezas  3
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Free article
Multicenter Study

Intravascular lithotripsy and temporary mechanical circulatory support for the treatment of heavily calcified coronary artery disease: insights from the BENELUX-IVL registry

Federico Oliveri et al. Heart Lung. 2025 Sep-Oct.
Free article

Abstract

Background: Intravascular lithotripsy (IVL) is increasingly utilized for the treatment of heavily calcified coronary lesions. However its use in conjunction with temporary mechanical circulatory support (tMCS) remains underexplored.

Objective: This study aims to evaluate the current use of tMCS and IVL for the treatment of heavily calcified coronary lesions.

Method: From the BENELUX-IVL prospective registry, patients who underwent IVL during PCI and required tMCS during the procedure were selected. The primary technical endpoint was procedural success <30%, defined as a composite of device success (the ability to deliver the IVL catheter across the target lesion, and delivery of IVL pulses without angiographic complications) with residual stenosis <30%, final Thrombolysis In Myocardial Infarction grade 3 flow, and no in-hospital major adverse cardiovascular events (MACE). The primary clinical outcome was in-hospital MACE, including cardiac death, non-fatal myocardial infarction, or target lesion revascularization.

Results: Between May 2019 and March 2024, a total of 454 patients were included, of whom 12 (2.6%) necessitated tMCS (for a total of 13 tMCS devices). Upon admission, the mean LV-EF was 39.5 ± 11.9%. The median Syntax score was 37 (25-49). A bail-out indication was the most common reason for tMCS initiation (58.3%), even if none was directly started due to IVL-related complications. Microaxial Flow Pump was the main utilized device (75%), followed by VA-ECMO (25%) and IABP (8.3%). One case required both VA-ECMO and Impella due to a coronary perforation complicated by cardiac tamponade. Procedural success < 30% was achieved in 91.6% of the cases. MACE occurred in one patient (8.3%).

Conclusion: In a large cohort of patients with complex heavily calcified coronary lesions requiring IVL, the need for tMCS was low (2.6%), with the main indication being bail-out.

Keywords: “Intracoronary lithotripsy”; “Intracoronary lithotripsy” AND “mechanical circulatory support”; “cardiogenic shock”; “coronary artery calcification”; “mechanical circulatory support”.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Disclosure: The Department of Cardiology of the Leiden University Medical Center received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. B.E.P.M. Claessen received consultancy fees from Abiomed, Abbott Vascular, Amgen, BBraun, Boston Scientific, Philips and Sanofi and received research funding from Philips, Novo Nordisk, BBraun and Infraredx. F. van der Kley received consultancy fees from Edwards Lifesciences and Abbott Vascular. JW Jukema/his department has received research grants from and/or was speaker (with or without lecture fees) on a.o.(CME accredited) meetings sponsored/supported by Abbott, Amarin, Amgen, Athera, Biotronik, Boston Scientific, Dalcor, Daiichi Sankyo, Edwards Lifesciences, GE Healthcare Johnson and Johnson, Lilly, Medtronic, Merck-Schering-Plough, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis,Shockwave Medical, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute and the European Community Framework KP7 Programme. JM. Montero received research funding from Shockwave Medical and speaker fees from Abiomed, Boston Scientific and Penumbra Inc. The remaining authors have no conflicts of interest to declare.

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