Coronary artery compliance : a comparative evaluation of non-compliant balloon angioplasty and intravascular lithotripsy

Intravascular lithotripsy (IVL) has demonstrated efficacy in treating balloon-crossable calcified coronary lesions by inducing calcium fractures and improving coronary artery compliance (CACom). However, a direct comparison between IVL and non-compliant (NC) balloon angioplasty with respect to compliance modification has not yet been reported.

From the BENELUX-IVL prospective registry, patients with calcified coronary artery lesions treated with IVL under intravascular ultrasound (IVUS) guidance were selected. CACom was calculated as the systo-diastolic change in luminal area (ΔA), measured using IVUS, divided by the corresponding change in aortic pressure (ΔP). CACom was assessed at three time points: (1) before NC balloon inflation (baseline), (2) after NC balloon inflation but prior to IVL (post-NC), and (3) after IVL pulse delivery (post-IVL). The NC balloon effect was defined as the difference between post-NC and baseline CACom; the IVL effect was defined as the difference between post-IVL and post-NC CACom.

CACom increased from 0.17 [0.12–0.23] at baseline to 0.32 [0.25–0.52] post-NC, and to 0.65 [0.44–0.84] post-IVL. The median NC effect was 0.14 [0.10–0.28] (p < 0.01), and the IVL effect was 0.23 [0.13–0.37] (p < 0.01). The IVL effect was significantly greater than the NC effect (p = 0.03).

Both NC balloon angioplasty and IVL significantly improved coronary compliance, with IVL yielding a greater compliance gain, supporting its role in optimizing lesion preparation in calcified coronary arteries.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.