Intravascular Lithotripsy in Peripheral Artery Disease
Carlos E Vazquez Sosa1, Aaqib Malik1, Jayakumar Sreenivasan1
1From the Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY.
Insights
Intravascular lithotripsy (IVL) offers a novel, low-risk solution for treating calcified peripheral artery disease. This ultrasound-based therapy effectively fractures calcium, enabling successful revascularization with promising safety data from initial trials.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Peripheral artery disease (PAD) impacts millions globally, increasing morbidity and mortality.
- Heavily calcified lesions pose significant challenges for interventional operators, with existing atherectomy devices carrying risks of complications like dissection and perforation.
Purpose of the Study:
- To evaluate the safety and effectiveness of Intravascular Lithotripsy (IVL) as a novel treatment modality for heavily calcified peripheral artery disease.
- To assess the procedural risks associated with IVL compared to traditional atherectomy devices.
Main Methods:
- Intravascular lithotripsy (IVL) utilizes a balloon catheter emitting high-energy ultrasound waves to fracture calcified plaques.
- Published data from five trials, including studies in common femoral and infrapopliteal arteries, were reviewed.
Main Results:
- IVL demonstrated encouraging safety and effectiveness in treating calcified stenoses.
- The available data indicate minimal procedural risk associated with IVL compared to existing atherectomy methods.
Conclusions:
- Intravascular lithotripsy presents a promising, low-risk option for revascularizing complex calcified peripheral artery disease.
- Further large-scale studies are warranted to fully understand the long-term outcomes and potential risks of IVL therapy.
Abstract:
Peripheral artery disease affects millions of people worldwide, and it is associated with significantly higher morbidity and mortality. In addition, it represents a significant challenge for the interventional operators to appropriately and successfully revascularize heavily calcified stenoses. There are several established atherectomy devices with the risk of procedural complications including dissection and perforation, among others. Intravascular lithotripsy (IVL) is a novel tool with relatively less procedural risk compared to the existing modalities. It is a device that emits high-energy ultrasound waves mounted on a balloon catheter that causes fractures on the calcium plaques allowing balloon expansion and luminal gain. Five trials have been published showing the safety and effectiveness of IVL, including one trial evaluating the device in common femoral artery and infrapopliteal arteries. The available data from the limited number of trials are very encouraging and demonstrates minimal risk. Additional studies on a larger scale are needed further to understand the its long-term effects and possible risks.
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