Management of Calcification: Rational and Technical Considerations for Intravascular Lithotripsy

Use of intravascular lithotripsy in non-coronary artery lesions

“…IVL use in iliofemoral arteries was mainly for treating heavily calcified and symptomatic peripheral artery disease[ 15 , 16 ] and providing large-bore vascular access for cardiovascular procedures such as transcatheter aortic valve replacement in patients with heavily calcified lesions[ 17 , 18 ].…”

“…IVL was used to improve vessel compliance and predilection before stent placement[ 16 ]. Several authors reported the use of IVL for severely calcified vessels before stent placement[ 16 , 19 ] or before treatment with drug-coated balloon angioplasty[ 20 ]. IVL was also used in severely calcified vessels as a stand-alone treatment without stent placement.…”

“…IVL was also used in severely calcified vessels as a stand-alone treatment without stent placement. Nasiri reported IVL use in the distal right anterior tibial artery as a stand-alone therapy with resolution of the slow blood flow[ 16 ].…”

“…Heavily calcified lesions present a challenge in endovascular procedures, and IVL has been shown to safely and effectively address the calcified lesions and improve vessel compliance[ 16 ]. One advantage of IVL is that it does not typically lead to distal emboli like many atherectomy procedures, and distal protection is usually unnecessary[ 16 , 24 ]. An exception is the atherectomy of the carotid arteries, where distal protection is still necessary due to the severe consequences of an embolus[ 21 ].…”

“…An exception is the atherectomy of the carotid arteries, where distal protection is still necessary due to the severe consequences of an embolus[ 21 ]. Furthermore, compared to atherectomy of a calcified lesion, IVL is a relatively quicker procedure, easy to learn, has a lower risk of vascular injuries such as vessel rupture or dissection, and more uniform plaque disruption[ 16 , 24 ]. In summary, we found that IVL was safely and successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral, carotid, subclavian, aorta, renal, and mesenteric vessels.…”