Intravascular lithotripsy during percutaneous coronary intervention: current concepts

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Medical Technology

Background:

• Severe coronary artery calcification (CAC) poses significant challenges during percutaneous coronary intervention, potentially leading to complications like stent underexpansion and thrombosis.
• Existing tools aim to manage CAC, but novel approaches are continuously sought to improve procedural success and patient outcomes.

Purpose of the Study:

• To review the evidence supporting the safety and efficacy of intravascular shockwave lithotripsy (IVL) for treating severely calcified coronary arteries before stenting.
• To discuss international real-world experiences with the coronary IVL system, including its application in acute coronary syndrome (ACS) and in-stent restenosis (ISR).

Main Methods:

• Review of existing literature and real-world data on the use of IVL for coronary calcium modification.
• Discussion of IVL's mechanism of action using acoustic pressure waves to fracture calcified lesions.

Main Results:

• IVL is a safe and effective therapy that successfully fractures coronary calcium.
• IVL facilitates optimal stent delivery and expansion in calcified coronary arteries.
• Real-world data supports IVL's utility in various clinical scenarios, including ACS and ISR.

Conclusions:

• IVL is a valuable tool for modifying coronary calcium, enhancing stent implantation.
• Long-term follow-up data is needed to fully understand the durability and late outcomes of IVL treatment.
• Randomized controlled trials are recommended to compare IVL with alternative calcium modification methods and explore its role in ACS.