State-of-the-Art Review
Principles of Intravascular Lithotripsy for Calcific Plaque Modification

https://doi.org/10.1016/j.jcin.2021.03.036Get rights and content
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Highlights

  • IVL has emerged as a novel therapy for treatment of vascular calcification.

  • IVL safely and effectively modifies calcified lesions via lithotripsy-driven fracture.

  • Understand longer-term outcomes following IVL modification of vascular calcification.

Abstract

A significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds exhibit moderate to severe calcific plaques known to portend lower procedural success rates, increased peri-procedural adverse events, and unfavorable clinical outcomes compared with noncalcific plaques. Adapted from lithotripsy technology used for treatment of ureterorenal calculi, intravascular lithotripsy (IVL) is a novel technique for the treatment of severely calcific plaque lesions that uses acoustic shockwaves in a balloon-based delivery system. Shockwaves induce calcium fractures, which facilitate stent expansion and luminal gain. In this review, the authors summarize the physics, preclinical and clinical data on IVL use in the coronary and peripheral vasculature, and future directions of IVL in transcatheter cardiovascular therapies.

Key Words

calcification
coronary artery disease
intravascular lithotripsy
peripheral artery disease

Abbreviations and Acronyms

CT
computed tomography
EHL
electrohydraulic lithotripsy
ESWL
extracorporeal shock-wave lithotripsy
ISWL
intracorporeal shock-wave lithotripsy
IVL
intravascular lithotripsy
OCT
optical coherence tomographic
RVD
reference vessel diameter
VF
ventricular fibrillation

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