Intravascular lithotripsy for calcified coronary lesions: insights across body mass index categories

Intravascular lithotripsy (IVL) has emerged as an effective treatment for balloon-crossable calcified coronary lesions. However, evidence on the safety and efficacy of IVL in overweight and obese patients remains limited.

From the prospective, multicenter BENELUX-IVL registry, conducted across nine hospitals in four European countries, patients undergoing PCI with IVL were selected. Patients were retrospectively stratified into three groups according to body mass index (BMI): normal weight (<25 kg/m²), overweight (25–30 kg/m²), and obese (≥30 kg/m²).

The primary efficacy endpoint was procedural success, defined as successful crossing and delivery of IVL pulses across the target lesion, residual stenosis <30% (assessed by QCA), final TIMI 3 flow, and absence of in-hospital major adverse cardiac events (MACE).

The primary safety endpoint was the occurrence of in-hospital MACE, including cardiac death, non-fatal myocardial infarction, or target vessel revascularization (TVR).

Among 514 patients (584 lesions), 36.2% were normal weight (n=186), 41.8% overweight (n=215), and 22.0% obese (n=113). Baseline clinical and angiographic characteristics (age, sex, SYNTAX score, clinical presentation, and angina severity) were comparable across groups. Intraprocedural complications were low and similar among groups (7.5%, 5.6%, and 4.4%, respectively; p=0.93), although a higher rate of hemodynamic instability was observed in the normal weight group (2.1% vs. 0% vs. 0%, p=0.03). Procedural success was high and comparable (88.7%, 88.8%, and 88.5%, respectively; p=0.99). In-hospital MACE occurred infrequently and with no significant differences (1.6%, 2.3%, and 1.8%; p=0.84). At one-year follow-up, MACE rates were 9.1%, 6.5%, and 6.2%, respectively (p=0.48).

In overweight and obese patients, IVL for the treatment of calcified coronary lesions proved to be a safe and effective strategy, with high procedural success rates and low incidence of device-related adverse events. Larger studies with longer-term follow-up are warranted to confirm these findings.