Coronary Artery Compliance Modification after Noncompliant Balloon Angioplasty and Intravascular Lithotripsy

Background 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. Methods From the BENELUX-IVL prospective registry (NCT06577038), 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. Results Twenty-four patients, for a total of 28 lesions, were pertinent for inclusion. CACom increased from 0.17 [0.12–0.23] mm 2 /mmHg at baseline to 0.32 [0.25–0.52] mm 2 /mmHg post-NC, and to 0.65 [0.44–0.84] mm 2 /mmHg post-IVL. The median NC effect was 0.14 [0.10–0.28] mm 2 /mmHg (p <0.01), and the IVL effect was 0.23 [0.13–0.37] mm 2 /mmHg (p <0.01). The IVL effect was significantly greater than the NC effect (p = 0.03). Conclusions sequential 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.