Objective To explore the effectiveness and safety of intravascular lithotripsy (IVL) in the treatment of severe coronary calcification lesions under the guidance of optical coherence tomography (OCT).

Methods Twenty patients with severe coronary calcifications treated in Affiliated Hospital of Jiangnan University from August 2022 to March 2023 were selected and pretreated with IVL under the guidance of OCT, and then drug-eluting stents (DES) were implanted. The OCT related data before IVL treatment, after IVL treatment and after stent implantation were compared, including the length, angle and thickness of calcified lesions, minimum lumen area, minimum lumen diameter, stent expansion coefficient, number of calcified fractures, stent expansion rate, index of plaque attention (IPA) and virtual fractional flow reserve (VFR). Major adverse cardiovascular events (MACEs) during the perioperative period were recorded.

Results Among the 20 patients, there were 12 males and 8 females, with an average age of (65.3 ±9.69) years. Compared with that before IVL, the minimum lumen diameter of the most severe calcified lesion was significantly increased after IVL (2.45±0.37 mm vs 2.64±0.33 mm, P < 0.05), and the minimum lumen area increased significantly after IVL (3.78±0.81 mm² vs 5.22±1.45 mm², P < 0.05), and the calcification angle decreased significantly after IVL (324.5±94.2° vs 284.3±79.4 °, P < 0.001). There was no significant change in calcification thickness and length. All lesions had calcification fractures, and 85% of them had more than 2 calcification fractures. The success rate of stent implantation was 100%, and the stent expansion rate was (97.10±5.28) %. After stent implantation, IPA was less than 110 and VFR was more than 0.8 in the most severe calcified lesions. No perioperative MACEs occurred in patients.

Conclusions Under the guidance of OCT, IVL pretreatment for severe coronary artery calcification lesions and stent implantation is safe and effective.