Clinical outcomes of intravascular lithotripsy according to the timing of stent failure - Insights from the COIL registry

Sep 30, 2026

Cumulative evidence supports intravascular lithotripsy (IVL) for patients with stent failure (SF), yet it remains unclear whether IVL effectiveness and subsequent clinical outcomes depend on when the index stent failed. A pre-specified COIL registry subgroup analysis evaluated SF treated with IVL, stratifying patients by SF timing: early (≤12 months), mid-term (12–36 months), and late (>36 months), with procedural and follow-up outcomes through 12 months. The primary endpoint combined cardiovascular death, spontaneous myocardial infarction, and target vessel revascularization. One-year results linked the primary endpoint to SF timing (8% vs 12% vs 29%, p=0.042), mainly driven by target vessel revascularization (3% vs 12% vs 29%, p=0.005).

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Background

Methods

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Introduction

ORIGINAL ARTICLE Cardiology Journal 2025, Vol. 32, No. 6, 546–554 DOI:10.5603/cj.103163 Copyright © 2025 Via Medica ISSN 1897–5593 eISSN 1898–018X Clinical outcomes of intravascular lithotripsy according to the timing of stent failure: Insights from the COIL registry Michał Kuzemczak 1–3 , Janusz Lipiecki4 , Jacek Legutko5, 6 , Johan Bennett7 , Joseph Dens8 , Mohammad Alkhalil9, 10 1Division of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland 2Department of Cardiology, Biegański Hospital, Medical University of Lodz, Lodz, Poland 3Department of Interventional Cardiology and Internal Diseases, Military Institute of Medicine—National Research Institute, Legionowo, Poland 4Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France 5Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland 6Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland 7Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium 8Ziekenhuis Oost-Limburg, Genk, Belgium 9Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom 10Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom Abstract Background: Cumulative data has highlighted the efficacy of intra-vascular lithotripsy (IVL) inpatients with stent failure (SF). However, it remains unclear whether the effectiveness of IVL, and subsequent clinical outcomes, are influenced by the timing of SF. We aimed to evaluate the outcomes of patients with SF undergoing IVL according to the age of index stent implantation. Methods: This is a pre-specified subgroup analysis of the COIL registry (coronary intravascular lithotripsy in patients with stent failure), which included patients who underwent IVL treatment for SF, divided according to the timing of SF, i.e., early (≤ 12 months), mid-term (12–36 months), and late SF (> 36 months). Procedural and clinical outcomes up to 12 months following IVL treatment were recorded. The primary endpoint was defined as the composite of cardiovascular death, spontaneous myocardial infarction, or target vessel revascularization (TVR). Results: There were 88 patients included in this sub-study, of whom 40 (45%), 17 (19%), and 31 (35%) had early, mid-term, and late SF, respectively. Final procedural results were better in those with early compared to mid-term or late SF. At one-year follow-up, the incidence of the primary endpoint was associated with the timing of SF (8% vs. 12% vs. 29%, p = 0.042). The difference among the subgroups was driven by TVR (3% vs. 12% vs. 29%, p = 0.005). Conclusions: Procedural and clinical outcomes following IVL treatment for patients with SF were influenced by the timing of index stent implantation. Further studies are needed to better understand the mechanisms behind recurrent SF. (CardiolJ 2025; 32, 6: 546–554) Keywords: percutaneous coronary intervention, calcification, IVL, in-stent restenosis Address for correspondence: Mohammad Alkhalil MD, Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, United Kingdom, tel.: +0191 233 6161, [e-mail: mohammad.alkhalil@nhs.net](e-mail: mohammad.alkhalil@nhs.net)[ ](e-mail: mohammad.alkhalil@nhs.net)[Received: 19.10.2024 Accepted: 7.08.2025 Early publication date: 4.09.2025](Received: 19.10.2024 Accepted: 7.08.2025 Early publication date: 4.09.2025) This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. 546 [www.cardiologyjournal.org](www.cardiologyjournal.org) Michał Kuzemczak et al., Timing of stent failure trea

FAQs

How were patients with stent failure grouped in this study?

Patients undergoing IVL for stent failure were divided by SF timing: early (≤12 months), mid-term (12–36 months), and late (>36 months) after index stent implantation.

What was the primary endpoint and what did the results show?

The primary endpoint was the composite of cardiovascular death, spontaneous myocardial infarction, or target vessel revascularization (TVR). Its incidence at one year was associated with SF timing (8% vs 12% vs 29%, p=0.042).

Which outcome mainly explained differences between early, mid-term, and late SF?

The difference was driven by TVR rates (3% vs 12% vs 29%, p=0.005), rather than the composite endpoint components overall.

Sep 30, 2026

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