Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Gruslova, Aleksandra B.; Inanc, Ibrahim H.; Cilingiroglu, Mehmet; Katta, Nitesh; Milner, Thomas E.; Feldman, Marc D.

doi:10.1002/ccd.30933

Cited by 2 publications

(1 citation statement)

References 81 publications

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“…[5][6][7][8] Intravascular lithotripsy (IVL) has emerged as a vessel/lesion preparation strategy to help overcome these issues. 9 The IVL device shatters the calcium within the atherosclerotic plaque using ultrasound (energy) via an angioplasty balloon. A recently completed randomised controlled trial (DISRUPT PAD III) involving 306 lesions (femoropopliteal stenoses or occlusions) treated with either IVL and angioplasty or conventional means (no IVL) showed that IVL resulted in greater procedural success, fewer dissections and comparable rates of major adverse events at 30 days.…”

Section: Introductionmentioning

confidence: 99%

SHOCkwave lithotripsy for patients with peripheral arterial disease: the SHOCC study

Lopez-Pena,

Musto,

Finch

et al. 2024

J.Vasc.Soc.G.B.Irel

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Objective: To assess the 6-month patency and clinical outcomes after endovascular treatment of lower limb atherosclerotic lesions in patients with peripheral arterial disease presenting with severe claudication or chronic limb threatening ischaemia (CLTI) using intravascular lithotripsy (IVL). Methods: A prospective multicentre cohort study was carried out in eight centres in the UK. Consecutive patients with CLTI or lifestyle-limiting claudication treated with IVL as a primary vessel preparation based on operator’s preference were included. Follow-up occurred at discharge, 30 days and 6 months with clinical and duplex assessments. A subset of patients underwent computed tomographic angiographic (CTA) lesion analysis pre-/post-IVL to assess plaque consistency/morphology using three-dimensional reconstruction of the CTA. Results: Overall, 91 patients (mean age 73 years, 72% male; 81% with CLTI) were enrolled in the study between September 2021 and March 2023 (21 took part in the CTA plaque imaging substudy). All patients with claudication had presented with severe lifestyle-limiting claudication and had calf claudication at <20 metres; those with CLTI all presented with Rutherford stage 5 or 6 disease. Immediate procedural success was 100%; 15 (16%) underwent a hybrid intervention. Mean target lesion peripheral artery calcification scoring system (PACCS) grade was 3.31±1.01. At the latest available follow-up (mean 183±75 days) there were 10 deaths (11%), one access complication (1%), two major cardiovascular events (2%) and eight major amputations (9%). A total of 22 re-interventions (24%) and freedom from clinically derived target lesion revascularisation at 6 months was 96% (95% CI 0.88% to 0.99%). Automated 3D plaque subgroup analysis (n=21) revealed >50% remodelling in calcium load within the plaque in 15 plaques (71%), only two dissections (9.5%) and a significant decrease in median plaque calcium load volume (from 7.8 cm3 preoperatively to 5.4 cm3 postoperatively). Conclusion: IVL is a safe and efficacious option for vessel preparation with high procedural success rates, acceptable medium-term complications and freedom from re-intervention.

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Section: Introductionmentioning

confidence: 99%

SHOCkwave lithotripsy for patients with peripheral arterial disease: the SHOCC study

Lopez-Pena,

Musto,

Finch

et al. 2024

J.Vasc.Soc.G.B.Irel

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Shockwave Intravascular Lithotripsy Use in the Femoro-Popliteal Segment: Considerations From an Expert Pan-European Panel Regarding Best-Care Practice

Saratzis,

Jane Messeder,

Thulasidasan

et al. 2024

J Endovasc Ther

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Purpose: Produce expert recommendations regarding the optimal use of Shockwave intravascular lithotripsy (IVL) when treating femoro-popliteal steno-occlusive peripheral artery disease (PAD), guiding operators to use Shockwave IVL. Materials and Methods: A modified 3-step Delphi process was used to gain consensus surrounding preoperative/intraoperative/postoperative considerations when using Shockwave IVL for femoro-popliteal PAD. This included a structured survey, focus-group (with qualitative thematic analysis of views expressed), and final confirmatory round; participants were recruited across Europe including the United Kingdom/Switzerland. Results: Following a review to inform an online survey, 25 experts took part in a survey (5 European countries, 2023), followed by a focus-group (15 participants), 9 interviews, and final confirmatory round. A list of recommendations was prepared where at least moderate-level or high-level agreement was reached (≥70% participants agreeing). The recommendations relate to the optimal preoperative imaging, preoperative preparation(s), intraoperative imaging and use of adjuncts, as well as postoperative course, when using Shockwave IVL. Conclusion: A list of expert recommendations is provided guiding the optimal use of Shockwave IVL in femoro-popliteal PAD. This will help operators achieve better clinical outcomes. Clinical Impact This pan-European panel of experts using intravascular lithotripsy in routine peripheral arterial disease endovascular practice has provided important insights into best care practices before, during, and after such procedures. Several recommendations have been produced based on a structured consensus process to guide clinicians globally. This will improve and standardise the use of this technology in the femoro-popliteal arterial segment.

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Review of intravascular lithotripsy for treating coronary, peripheral artery, and valve calcifications

Cited by 2 publications

References 81 publications

SHOCkwave lithotripsy for patients with peripheral arterial disease: the SHOCC study

SHOCkwave lithotripsy for patients with peripheral arterial disease: the SHOCC study

Shockwave Intravascular Lithotripsy Use in the Femoro-Popliteal Segment: Considerations From an Expert Pan-European Panel Regarding Best-Care Practice

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