Endovascular revascularisation in chronic occlusive mesenteric ischaemia: safety and efficacy of intravascular lithotripsy.

objectiveTo evaluate the safety and efficacy of intravascular lithotripsy (IVL)-assisted endovascular revascularisation in patients with chronic mesenteric ischaemia (CMI) and heavily calcified mesenteric artery stenoses. MATERIALS AND

methodsIn this single-centre retrospective study (May 2020-June 2025), consecutive patients with symptomatic CMI, ≥ 50% mesenteric artery stenosis, and moderate-to-severe calcification on CT angiography underwent IVL-assisted endovascular revascularisation. Outcomes included technical success (successful IVL with ≤ 30% residual stenosis after any adjunctive therapy), moderate-to-severe adverse events (AEs), symptom recurrence, clinically driven target vessel revascularisation (CD-TVR), patency, and survival. Kaplan-Meier analysis assessed patency and survival at 6 and 12 months.

resultsFifty-one patients (median age, 71.5 years; 51% women) underwent treatment of 57 arteries (median stenosis, 72.0%; 96.5% moderate-to-severe calcification). IVL was followed by stenting in 53 de-novo lesions (47 bare-metal, 6 covered), and balloon angioplasty in 4 lesions (3 de-novo, 1 in-stent restenosis). Technical success was 93.0%, with predilatation required in 45.6% of vessels. Median residual stenosis was 16.7% (IQR 11.7), and median lumen gain was 3.5 mm (IQR 2.1). Moderate-to-severe AEs occurred in 27.5% of patients. Two patients were lost to follow-up. During a median follow-up of 578.0 days (IQR 529.5), symptom recurrence occurred in 18.4% of patients, and CD-TVR was required in 16.3%. Primary clinical patency was 93.4% at 6 months and 91.0% at 12 months. Survival rates were 91.7% and 89.4% at 6 and 12 months, respectively; mesenteric ischaemia-related mortality was 2.0%.

conclusionIVL is a safe and effective vessel preparation strategy for heavily calcified mesenteric arteries, facilitating endovascular revascularisation in CMI. KEY POINTS: Question Can vessel preparation with intravascular lithotripsy reduce the rate of endovascular treatment failure associated with moderate-to-severe calcification in mesenteric artery stenosis without amplifying procedural risks? Findings Calcium modification with intravascular lithotripsy prior to stenting yielded high technical and clinical success with favourable lumen gain, safety profile, and durable patency. Clinical relevance Adjunctive intravascular lithotripsy is a valuable strategy to mitigate the challenges of calcification in mesenteric artery stenosis, achieving high technical and clinical success while preserving procedural safety, thereby broadening treatment feasibility and improving outcomes in complex disease.