Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Medical Technology Assessment

Background:

• Intracoronary calcium (ICC) presents significant challenges in interventional cardiology.
• Advances in calcium treatment devices have emerged, yet a knowledge gap persists regarding optimal device selection.
• Understanding the nuances of different devices is crucial for effective management of calcified lesions.

Purpose of the Study:

• To review the fundamental principles and clinical evidence supporting intravascular lithotripsy (IVL).
• To compare IVL techniques and outcomes against alternative devices for treating calcified cardiovascular lesions.
• To address key controversies and practical considerations in the application of IVL.

Main Methods:

• Systematic review of principles and clinical data for intravascular lithotripsy (IVL).
• Comparative analysis of IVL with existing devices for coronary, peripheral artery, and valvular calcifications.
• Discussion of clinical controversies including device integration, calcium subtype management, and procedural optimization.

Main Results:

• Intravascular lithotripsy (IVL) demonstrates efficacy in treating complex calcified lesions across various vascular beds.
• Clinical data supports IVL as a viable option, with specific advantages in certain calcification subtypes and challenging anatomies.
• Comparative data highlights the evolving landscape of calcium modification devices and their respective roles.

Conclusions:

• Intravascular lithotripsy (IVL) offers a valuable tool for interventional cardiologists managing intracoronary calcium (ICC).
• Evidence supports IVL's safety and effectiveness, guiding its incorporation into treatment strategies for coronary, peripheral, and valvular calcifications.
• Further research and practical experience will refine optimal techniques and patient selection for IVL.