Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification

Abstract

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.

Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction

“…16 Li-ESWT has since become recognized for its potential clinical therapeutic effects in the treatment of various musculoskeletal pathologies, [17][18][19] Peyronie's disease, [20][21][22] chronic prostatitis/chronic pelvic pain syndrome, 23,24 chronic wound treatments, 25,26 and several cardiovascular pathologies. [27][28][29][30][31][32] In 2010, Li-ESWT began to be explored as an alternative means of treating ED, 33 with the first randomized controlled trial (RCT) published in 2012. 34 The benefits of Li-ESWT stems from its ability to induce microtrauma.…”

Intravascular Lithotripsy Facilitated Cardiovascular Interventions

“…Kassimis et al wrote a comprehensive review on intravascular lithotripsy (IVL; Shockwave Medical, Inc) in a recent issue of Angiology journal. 1 Intravascular lithotripsy is a novel device utilized for modification of heavily calcified atherosclerotic plaque within peripheral arteries as well as de novo coronary lesions. We commend the authors 1 for providing an exhaustive analysis covering current observational and randomized supporting evidence.…”

“…1 Intravascular lithotripsy is a novel device utilized for modification of heavily calcified atherosclerotic plaque within peripheral arteries as well as de novo coronary lesions. We commend the authors 1 for providing an exhaustive analysis covering current observational and randomized supporting evidence. We would like to comment on further innovative applications of IVL in the management of calcified lesions.…”

Reply to the Letter to the Editor Entitled “Intravascular Lithotripsy Facilitated Cardiovascular Interventions”

“…We thank Butt et al for their interest 1 in our recently published article on Shockwave intravascular lithotripsy (IVL) for the treatment of severe vascular calcification. 2 Heavily calcified coronary and peripheral artery lesions hamper percutaneous revascularization and impact interventional outcomes by impairing device crossing, impairing stent apposition and expansion, and disrupting drug and polymer release kinetics. 3 Intravascular lithotripsy offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels.…”

“…It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus, modifying transmural conduit compliance. 2 In addition to the coronary technology, a growing number of interventionalists are adopting the use of IVL to facilitate percutaneous access in procedures that require large bore catheter delivery systems. 4 In these cases, IVL fractures calcium, increasing the luminal diameter and improving compliance, which allows the device to safely pass through the iliac artery and ultimately be delivered and placed in the heart.…”