Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis

BACKGROUND: Intravascular lithotripsy (IVL) has emerged as a novel technology for modifying calcified coronary lesions, whereas optical coherence tomography (OCT) enables high-resolution assessment of calcium modification and procedural outcomes. However, the mechanistic and procedural effects of IVL assessed by OCT across studies remain incompletely characterized. METHODS: A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261332946). PubMed/MEDLINE, Cochrane Library, and Epistemonikos were searched from inception through February 2026. Randomized controlled trials and observational studies with extractable quantitative OCT outcomes were included. The primary endpoint was OCT-detected calcium fracture. Secondary endpoints included multiple calcium fractures, minimum stent area (MSA), stent expansion, acute lumen gain, procedural success, and in-hospital major adverse cardiovascular events (MACEs). Random-effects meta-analyses were performed to estimate pooled proportions or mean values with 95% confidence intervals (CIs). RESULTS: Thirty studies encompassing a total of 3030 patients were included. OCT-detected calcium fracture occurred in 68% (95% CI 56%-79%) of lesions, whereas multiple fractures were observed in 34% (95% CI 26%-41%). IVL-treated lesions achieved favorable procedural metrics, including a pooled final MSA of 6.45 (95% CI 6.07-6.82) mm2, stent expansion of 85.9% (95% CI 82.3%-89.5%), and acute lumen gain of 3.50 (95% CI 3.14-3.87) mm2. Procedural success was high (95%, 95% CI 93%-98%) with low in-hospital MACEs (2%, 95% CI 1%-3%). Substantial heterogeneity was observed across endpoints. CONCLUSIONS: Coronary IVL assessed by OCT is frequently associated with calcium fracture and favorable procedural outcomes with high procedural success and low early adverse events.