Post IVL Coronary Compliance

Calcified coronary lesions represent one of the most relevant technical challenges in percutaneous coronary intervention (PCI). Its presence has been directly linked to stent underexpansion, which leads to worse clinical outcomes. 

Coronary compliance reflects the vessel capacity to expand or contract in response to aortic pressure changes during a cardiac cycle. This may be quantified invasively by IVUS, assessing systo-diastolic change in the luminal area (ΔA), influenced by multiple factors, such as atherosclerosis burden, anatomical location and coronary physiology. 

Intravascular lithotripsy (IVL) has surged as an effective and safe alternative for the treatment of coronary lesions, with the capacity to induce fractures in deep calcium. However, the hypothesis stating these fractures will improve with coronary compliance, and that such change could predict better stent expansion, is yet to be confirmed. 

The BENELUX-IVL registry included 49 consecutive patients with severely calcified coronary lesions treated with IVUS guided IVL. Coronary compliance was assessed before and after procedure, defined as systolic-diastolic change in lumen area relative to the corresponding change in aortic pressure (ΔA/ΔP × 100).

The primary end point was CACom change (ΔCACom) and its correlation analysis against new fractures and stent expansion (SE) indices. Secondary end points included assessing ΔCACom as independent predictor of SE, either in terms of minimum stent area (MSA) or eccentricity index.

Read also: Ischemia by Dobutamine Stress Echocardiography as a Predictor of PCI Efficacy.

Mean patient age was 74, and 22,4% were women. IVUS parameters revealed mean MSA 10,19 ± 0,34 mm², mean SE 78,6 ± 1,6%, and SE >80% in 44,9% of cases. Post IVL calcified fractures were identified in 75,5% of patients. Procedural success rate (residual stenosis <30%) was 98%, with only one in-hospital major complication (2,0%: cardiac death).

Mean ΔCACom was 0,33 mm²/mm Hg (RCI: 0,19–0,70; p<0,01). At multivariable analysis, ΔCACom maintained as the sole independent predictor both of SE in MSA (R=0,420; p=0,044) and SE >80% in MSA (OR: 6,58; CI 95%: 1,24–34,90; p=0,043).

We should note that CACom after IVL (post-CACom) was not significantly associated to these outcomes, which highlights the importance of relative change (ΔCACom) over final absolute compliance value.

Read also: Side Branch Treatment in Bifurcation Lesions: Are Drug-Coated Balloons Better?

This finding aligns with calcified lesion physiopathology, where compliance remains limited even after a successful intervention. 

Conclusions

Improved post IVL coronary compliance was independently associated as adequate predictor of stent expansion (SE and SE >80%). This provides a functional, dynamic and real time metrics, that could guide optimal lesion preparation during PCI, minimizing the need for additional more aggressive techniques. 

Original Title: Coronary Compliance Modification by Intravascular Lithotripsy: New Predictor of Stent Expansion in Calcified Coronary Lesions.

Reference: Oliveri F, Van Oort MJH, Al Amri I, Bingen BO, Claessen BE, Dimitriu-Leen AC, Kefer J, Girgis H, Vossenberg T, Van der Kley F, Jukema JW, Montero-Cabezas JM. Coronary Compliance Modification by Intravascular Lithotripsy: New Predictor of Stent Expansion in Calcified Coronary Lesions. J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(5):102635. doi: 10.1016/j.jscai.2025.102635. PMID: 40454281; PMCID: PMC12126079.