TCT-653 Intravascular Lithotripsy for Lesion Preparation in Calcified Coronary Lesions: First Data of Prospective, Observational Multicenter Registry

Coronary intravascular lithotripsy for coronary artery calcifications- systematic review of cases

“…The procedural complications may include slow flow, lack of reflow, distal embolization, perforation, and arterial dissection. There were four cases of coronary artery dissection in Disrupt CAD I trial and in the study by Aksoy et al whereas only two patients experienced Type B and C dissection in Disrupt CAD II study [9,11]. Our review also showed procedural complications in 2 patients out of 24, the most common reported complication was coronary artery dissection.…”

“…In addition, the acute luminal gain after S-IVL was 2.1 mm in Disrupt CAD I and 1.67 mm in Disrupt CAD II [7,8]. The study by Aksoy et al also supports these findings as to the mean luminal gain after S-IVL and post-stenting were 0.89 mm and 1.87 mm, respectively, [11]. Since severe calcification is an important predictor of restenosis after PCI, a pre-treatment with S-IVL can potentially increase the vessel diameter and ensure effective stent placement.…”

“…Another prospective trial, Disrupt CAD II, that studied 120 cases with extensive calcification from nine countries; also reported successful outcomes with residual stenosis of 7.8 ± 7.1% and stent delivery in 100% cases [8]. A recent prospective observational study of 78 calcified lesions by Aksoy et al has shown a significant reduction in mean diameter stenosis of up to 26.7 ± 4.3% after S-IVL therapy [11]. Similar results are seen in a retrospective study by Wong et al who reported residual stenosis of <20% in all 26 cases [12].…”

Intravascular lithotripsy to treat an ostial left main coronary artery stenosis due to porcelain aorta in a patient with congenital HDL deficiency

“…Via a balloon inflated in the vessel, IVL delivers pulsatile sonic pressure waves converted to mechanical energy that may modify vascular calcium by the induction of calcium fractures, allowing for proper stent expansion ( 4 ). Recently, a registry including 71 patients and a prospective study with 120 patients with calcified coronary lesions demonstrated the safety and effectiveness of the IVL technique ( 5 , 6 ). In some case series, IVL has been used with success in the case of stent underexpansion resistant to conventional approaches ( 7 , 8 ).…”

SCAI guidelines on device selection in Aorto‐Iliac arterial interventions

“…Intravascular lithotripsy (Shockwave Medical, Santa Clara, CA) functions by incorporating lithotripsy emitters within an angioplasty balloon, such that sonic pressure waves drive through surrounding tissue selectively fracturing vascular calcium within the vessel wall, thus purportedly altering vessel compliance and permitting vessel dilatation at relatively low pressures. Early studies with intravascular lithotripsy have demonstrated feasibility for the management of severely calcified arterial stenoses in coronary and peripheral arteries 50‐54 . With respect to Ao‐I artery revascularization, several case reports have demonstrated potential value in the management of Ao‐I occlusive disease, 55 particularly when large bore catheter access is required, 56 however, RCTs for an Ao‐I application are yet to be performed.…”