Abstract
INTRODUCTION: Intravascular lithotripsy (IVL) has a strong safety and efficacy profile for managing calcified coronary lesions during percutaneous coronary intervention (PCI). Nevertheless, evidence on its application in left main (LM) disease remains scarce. AIM: This study aimed to evaluate procedural success, efficacy, safety, and two-year clinical outcomes of IVL in LM PCI. MATERIAL AND METHODS: The analysis included 53 patients who underwent LM PCI using the Shockwave C2 and C2+ IVL systems beginning in April 2020. Outcomes were compared with those of 148 patients who underwent non-LM PCI during the same period. RESULTS: The two groups were similar in age. Non-ST elevation myocardial infarction (NSTEMI) (43.4% vs. 23.6%; p = 0.006) and heart failure history were more common in the LM cohort (47.2% vs. 29.1%; p = 0.017). Larger IVL balloon diameters were chosen in LM lesions, with less use of 3.0 mm balloons (24.5% vs. 44.6%; p = 0.016) and more use of 4.0 mm balloons (15.1% vs. 2.0%; p < 0.001). Intravascular imaging (IVUS/OCT) was performed in nearly every LM case (94.3% vs. 40.5%; p < 0.001). IVL success rates were high in both groups (100% vs. 96.6%; p = 0.400), as were overall procedural success rates. No cases of coronary artery perforation or slow-flow/no-reflow phenomena were recorded. During long-term follow-up, there were no differences between the LM and non-LM cohorts in all-cause mortality (14.8% vs. 6.3%; p = 0.087) or major adverse cardiovascular events (MACE) incidence (6.7% vs. 9.0%; p = 0.582). CONCLUSIONS: In LM PCI, IVL demonstrates a favorable safety and efficacy profile, achieving high technical success rates and long-term outcomes, including MACE rates comparable to those observed in non-LM PCI.