Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions

Purpose of review: Intravascular lithotripsy (IVL) is a novel tool for calcified lesion modification using acoustic pressure waves. In this review, we discuss its use to treat calcified coronary lesions, including technique, mechanism of action, clinical practice, current evidence, advantages and disadvantages, and its role in specific lesion subsets. Recent findings: Prospective studies, the “Shockwave Coronary Rx Lithoplasty^® Study” Disrupt CAD I, II, and III have demonstrated that IVL is safe and effective to prepare calcific stenotic lesions for stent deployment. Summary: IVL is a novel, facile technology to modify coronary calcification that is associated with a low risk for intra-procedural complications. It can be used upfront or as a bailout in combination with other modalities for calcium modification. While it is easier to use than other atherectomy devices, there are no robust comparative data on outcomes or cost-effectiveness. Further studies are needed to define its role in specific complex lesions.