Abstract: Background: The effectiveness of intravascular lithotripsy (IVL) in terms of anatomical and physiological results in different subtypes of calcifications is unknown.
Methods: Lesions treated with IVL-percutaneous coronary intervention (PCI) were stratified according to hemodynamic pattern (focal/diffuse) and calcification phenotypes (concentric/eccentric). All lesions were analyzed with optical coherence tomography (OCT), OCT-based fractional flow reserve (OFR) and quantitative flow ratio (QFR). The outcomes were post-PCI OFR/QFR values, minimal stent area (MSA) and angio-derived index of microvascular resistance (Angio-IMR).
Results: 88 lesions were included. All parameters significantly increased during PCI. Diffuse lesions showed lower post-PCI values of OFR (focal = 0.92 (0.89-0.95) vs diffuse = 0.88 (0.85-0.91), P < 0.01), QFR (focal = 0.94 (0.89-0.98) vs diffuse = 0.87 (0.85-0.90); P < 0.01) and MSA (focal = 6.40 (5.80-7.10) mm2 vs diffuse = 5.40 (4.80-6.00) mm2, P = 0.02). Angio-IMR changes were comparable between the two groups. No differences were evident between concentric and eccentric lesions for any outcomes assessed.
Conclusions: Diffuse lesions were associated with suboptimal anatomical and physiological results following IVL-PCI, while no differences were evident between concentric and eccentric calcification phenotypes.
