Principles of Intravascular Lithotripsy for Calcific Plaque Modification

Best Practice in Intravascular Lithotripsy

“…Intravascular lithotripsy (IVL) is a new vessel preparation technique for calcified coronary artery lesions that creates multiplane micro/macro fractures in the calcified plaque before stenting or allowing for an improved stent expansion. 8 The C2 Shockwave Medical Coronary IVL system (Shockwave Medical) consists of three components: a generator; a connector cable and a sterile catheter incorporating the lithotripsy emitters enclosed in a semi-compliant balloon (Figure 1). IVL emitters produce electric sparks that create vapour bubbles in the surrounding fluid medium in the integrated balloon.…”

Emergency Intravascular Aortic and Iliac Artery Lithotripsy to Facilitate Thoracic Endovascular Aortic Repair of a Ruptured Thoracic Aortic Aneurysm: A Case Report

“…The lithotripter generates acoustic waves and compressive stress that fractures the calcifications. 8 IVL has become an important addition or an alternative to conventional angioplasty and atherectomy. Yet, unlike angioplasty, IVL does not require high-risk bailout stenting or stent grafting in severely calcified vessels, and, unlike atherectomy, it fractures calcification of both the intimal and the medial layers while minimally affecting the soft tissue of the vessels.…”

“…Yet, unlike angioplasty, IVL does not require high-risk bailout stenting or stent grafting in severely calcified vessels, and, unlike atherectomy, it fractures calcification of both the intimal and the medial layers while minimally affecting the soft tissue of the vessels. 4,5,8,9 The Shockwave peripheral IVL catheter (Shockwave Medical Inc) is delivered on a semicompliant balloon filled with saline-contrast mix and equipped with acoustic wave emitters. 9 The balloon is inflated to relatively low subnominal pressure (4 atm) and brought into apposition with the vessel wall without stretching it 5 while decreasing the risk of distal embolization, dissection, and rupture.…”

“…9,10 The acoustic wave emitters distributed along the length of the balloon are aligned in channels that pulse at 1 Hz generating circumferential and transmural pressure and a localized energy field effect sufficient for fracturing calcium within the vessel. 8 After several cycles of treatment, the balloon is inflated to nominal pressure (6 atm) to maximize vessel diameter and then deflated to repeat the treatment or to be repositioned, as required, for the treatment of another lesion. Arterial access is a major challenge in complex endovascular procedures requiring large-bore sheaths.…”

Evaluation of the Safety and Efficacy of Coronary Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Stenoses: Evidence From the Serial Disrupt CAD Trials

“…In this study, OCT was used to evaluate the mechanism of action of IVL quantifying the CAC characteristics and calcium plaque fracture. Calcium plaque fracture is considered as a new rupture and/or discontinuity of the calcium plaque found on OCT after IVL or stent implantation (29). In order to determine the number of fractures in each lesion, the continuity of calcium plaque fracture was tracked in the whole lesion frame by frame and cross-examined with longitudinal OCT images (12,30).…”