Pain and Anxiety During Intravascular Lithotripsy-Assisted Percutaneous Coronary Intervention Compared with Conventional PCI: A Prospective Single-Center Observational Study

Abstract Background: Intravascular lithotripsy (IVL) is an effective treatment for severely calcified coronary lesions during percutaneous coronary intervention (PCI). However, data regarding patient-reported pain and anxiety during IVL are limited. Objective: To compare pain and anxiety levels in patients undergoing IVL-assisted PCI with those undergoing conventional PCI. Methods In this prospective single-center observational study, 100 patients with chronic coronary syndrome undergoing PCI between 2024 and 2025 were enrolled. Fifty patients underwent IVL-assisted PCI and 50 underwent conventional PCI. Pain was assessed using the Numeric Rating Scale (NRS) and Wong-Baker FACES Pain Rating Scale, while anxiety was assessed using the Subjective Units of Distress Scale (SUDS). Results Baseline demographic characteristics were similar between groups. The IVL group had more complex coronary artery disease, including a higher prevalence of three-vessel disease (70% vs. 38%, p = 0.001), more previous coronary angiographies ( p = 0.007), and higher radiation exposure ( p = 0.018). Despite greater lesion complexity, no significant differences were observed in pain or anxiety scores between groups. The number of IVL pulses was not associated with pain or anxiety. Conclusions IVL-assisted PCI was not associated with increased pain or anxiety compared with conventional PCI despite greater procedural complexity. These findings support IVL as a well-tolerated strategy for the treatment of severely calcified coronary lesions.