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Observational Study
. 2025 Aug;106(2):869-878.
doi: 10.1002/ccd.31637. Epub 2025 May 27.

Comparison of Procedural and Clinical Outcomes of Angiography- Versus Imaging-Guided Percutaneous Coronary Intervention With Intravascular Lithotripsy

Akshay A S Phagu  1 , Martijn J H van Oort  1 , Federico Oliveri  1 , Brian O Bingen  1 , Gianluca Mincione  2 , Valeria Paradies  2 , Bimmer E P M Claessen  3 , Aukelien C Dimitriu-Leen  4 , Tessel N Vossenberg  5 , Joelle Kefer  6 , Hany Girgis  7 , Frank van der Kley  1 , J Wouter Jukema  1   8 , Ibtihal Al Amri  1 , Jose M Montero-Cabezas  1
Affiliations
Observational Study

Comparison of Procedural and Clinical Outcomes of Angiography- Versus Imaging-Guided Percutaneous Coronary Intervention With Intravascular Lithotripsy

Akshay A S Phagu et al. Catheter Cardiovasc Interv. 2025 Aug.

Abstract

Background: Intravascular lithotripsy (IVL) is an innovative treatment for coronary artery calcification (CAC).

Aims: This study aimed to compare procedural and clinical outcomes of intracoronary imaging (ICI)-guided percutaneous coronary intervention (PCI) versus angiography-guided PCI with IVL in patients with CAC.

Methods: A total of 509 patients were analyzed from the BENELUX-IVL registry (May 2019 to September 2024). Angiography-guided PCI with IVL was defined as therapy under solely fluoroscopic guidance. ICI-guided PCI with IVL was defined as PCI with IVL and concomitant use of ICI for procedural guidance either pre- and/or post-IVL. The primary endpoint was procedural success, defined as Thrombolysis In Myocardial Infarction (TIMI) 3 flow, residual stenosis < 30%, and absence of in-hospital major adverse cardiovascular events (MACE). Safety endpoints included procedural complications and MACE up to 2-year follow-up.

Results: A total of 537 lesions were treated with IVL: 252 (46.9%) angiography-guided and 285 (53.1%) ICI-guided. The ICI-guided group had more complex lesions, with higher rates of aorto-ostial (20.2% vs. 30.9%; p = 0.005), chronic total occlusions (2.8% vs. 12.3%; p = 0.001), and long-segment lesions (58.7% vs. 69.5%; p = 0.009). Procedural success rates were comparable between groups (88.7% vs. 89.7%; p = 0.71), as were device success (97.9% vs. 97.4%; p = 0.72) and technical success (89.1% vs. 91.5%; p = 0.35). MACE rates remained similar at all time points up to 2-year follow-up (p > 0.05).

Conclusion: Procedural success was comparable between angiography-guided and ICI-guided PCI with IVL, despite greater lesion complexity in the ICI-guided group. Complication rates were similar, with no significant differences in MACE or mortality at long-term follow-up.

Keywords: angiography‐guided versus imaging‐guided IVL; coronary artery calcification (CAC); intravascular lithotripsy (IVL); intravascular ultrasound (IVUS) and optical coherence tomography (OCT); percutaneous coronary intervention (PCI).

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Conflict of interest statement

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. I.A.A. received speaker fees from Penumbra Inc. and Medtronic. B.E.P.M.C. reports relations with Sanofi, Philips, Amgen, Boston Scientific Corp, and AbioMed Inc that include consulting or advisory. T.N.V. received consultancy fees from Boston Scientific and Cardiac Dimensions. Drs J.K. has served as a proctor for Abbott. F.v.d.K. received consultancy fees from Edwards Lifesciences and Abbott Vascular. F.v.d.K. received consultancy fees from Edwards Lifesciences and Abbott Vascular. J.W.J./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. J.M.M.‐C. received a research grant from Shockwave Medical and speaker fees from Abiomed, Boston Scientific, and Penumbra Inc. The other authors declare no conflicts of interest.

Figures

Central Illustration 1
Central Illustration 1
Comparison of angiography‐ versus imaging‐guided percutaneous coronary intervention with intravascular lithotripsy. ICI = intracoronary imaging, MACE = major adverse cardiovascular events. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 1
Figure 1
Two‐year major adverse cardiovascular event‐free survival of patients treated with intravascular lithotripsy. ICI = intracoronary imaging, MACE = major adverse cardiovascular events. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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