Intravascular lithotripsy during percutaneous coronary intervention: current concepts

Introduction: Coronary artery calcification (CAC) is commonly encountered by interventional cardiologists. Severe CAC may impair stent delivery or result in stent underexpansion, stent thrombosis and/or  in-stent restenosis (ISR). Multiple tools have been developed to help overcome the challenges associated with CAC and improve outcomes for these patients. Intravascular shockwave lithotripsy (IVL) is a  novel therapy that uses acoustic pressure waves for the modification of CAC. Areas covered: This review discusses the growing body of evidence to support the safety and efficacy  of IVL in the setting of de novo severely calcified coronary arteries prior to stenting. We also discuss  international real-world experience with the coronary IVL system. This includes the use of IVL in the  setting of acute coronary syndrome (ACS), ISR and in combination with other tools for calcium  modification. Expert opinion: IVL is a safe and effective therapy that results in the fracture of coronary calcium  and facilitates optimal stent delivery and expansion. Longer term follow-up is essential to shed light  on the durability and late outcomes of an IVL strategy. Randomized control trials are warranted to  compare IVL to alternative methods of calcium modification and to explore further the use of IVL  for ACS.