Calcified Plaque Detachment: Alternative Calcified Plaque Modification After Coronary Intravascular Lithotripsy

BACKGROUND: Calcified plaque (CP) detachment (CD) and calcium fracture (CF) can occur following coronary intravascular lithotripsy (IVL). The extent to which CF alone facilitates stent expansion during CP modification with IVL remains unclear. AIMS: This study aimed to investigate the clinical implications of IVL-induced CD. METHODS: Optical coherence tomography was performed to assess coronary CP immediately after IVL in 45 consecutive patients for whom images were available. CD was defined as partial or complete separation of the CP from either the coronary artery intima or media. The study population was divided into CD and non-CD groups. RESULTS: CD was observed in 22 patients (49%) without associated major dissection, intramural hematoma, or slow flow, whereas CF was observed in 35 patients (78%). No significant differences were found in baseline characteristics between the groups. The stent expansion index was not significantly different between the groups (77.6% vs. 83.2%, p = 0.17). Across increasing calcium arc grades, CD frequency decreased significantly (p = 0.01), whereas CF frequency increased (p = 0.02). CONCLUSIONS: CD frequently occurs in patients undergoing coronary IVL, with CP separation from the vessel wall proceeding safely and without coronary flow impairment. In addition to CF, CD may contribute to CP modification, facilitating lumen enlargement and successful stent deployment.