Background: Calcified coronary artery lesions pose challenges to device delivery and procedural success in percutaneous coronary intervention (PCI). With increasing burden of coronary artery calcification, lesion modification and optimization is of utmost importance. Shockwaveintravascular lithotripsy (IVL) is a new technology that utilizes pulsatile ultrasound waves and mechanical energy to disrupt calcified coronary lesions. Drug-coated balloon(DCB) angioplasty is a feasible treatment option in PCI with an attractive strategy of leaving nothing behind. There is limited data on the outcomes of a novel combination of IVL and DCB angioplasty for treatment of calcified coronary arteries.  We hereby present our short-term clinical outcomes. 

Methods: We retrospectively reviewed all patients treated with IVL and DCB angioplasty during PCI for de-novo calcific coronary lesions between September 2019 to March 2021.

Results: A total of 7 patients underwent IVL and DCB-only PCI (71% male, mean age 81). Indications for PCI include acute coronary syndrome (72%), heart failure (14%) and angina (14%). Mean baseline left ventricular ejection fraction was 42 + 15%. Angiographic success (<30%residual stenosis) occurred in 6 patients (86%), while 1 patient had residual 50% stenosis. No major intraprocedural complications were recorded. Major adverse cardiac event (Cardiac death, myocardial infarction, target vessel revascularization) occurred in 2 patients (28%). One of whom died from end stage heart failure at 7 months while the other had a myocardial infarction involving a different vessel from index PCI at 6 months. No cases of  target vessel revascularization and lesion thrombosis were reported. 

Conclusion: Our preliminary experience shows that novel use of IVL and DCB-only angioplasty for treatment of calcified coronary arteries is safe and feasible with low event rate (intra-procedure and follow-up). However, more data are required to establish the long-term safety and efficacy of this novel “all-balloon” approach.