Intravascular lithotripsy: An established frontier for calcific plaque modification

Abstract

Background: Coronary artery calcification is often found in patients with severe coronary artery disease. It is often regarded as one of the difficult frontiers to conquer in coronary stenting. Higher the coronary artery calcium score, the more challenging it is to modify the plaque prior to Percutaneous Coronary Intervention (PCI). Intravascular lithotripsy (IVL) is an evolving technology that utilizes acoustic shockwaves to create calcium fractures specifically disrupting both shallow and deep deposits of calcium in the intima and the media of coronary arteries.
Methods: Online databases such as PubMed and Google Scholar were explored, and all relevant publications were analyzed. Keywords utilized during our search were intravascular lithotripsy, shockwaves, coronary lithotripsy, calcified atheromatous plaques and coronary artery calcification. All the gathered information has been scoured to summarize the pre-clinical and clinical data on IVL and to provide a bird’s eye view on the prospects of this novel technique in trans catheter coronary intervention.
Results: Studies indicate that IVL causes better stent placement and expansion when used prior to PCI. IVL demonstrated high procedural success rates (93-97%) and favorable clinical outcomes, with low rates of major adverse cardiovascular events. Comparisons with alternative modalities highlighted IVL's superiority in managing severely calcified lesions, with fewer vascular complications and a shorter learning curve. IVL also causes an improvement in vessel compliance with minimal soft-tissue loss, thereby making successful PCI of calcified plaques more efficacious and simpler achieving higher clinical success, better acute lumen gain and lesser residual stenosis with IVL.
Conclusion: IVL is helpful in the preparation of calcified plaques for PCI. The success rate of drug eluting stent placement in IVL assisted PCI can approach 100% with excellent safety.