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Calcific Plaque Modification by Acoustic Shockwaves: Intravascular Lithotripsy in Coronary Interventions.

Constituting a significant proportion of lesions treated with transcatheter interventions in the coronary arteries, moderate to severe calcification portends lower procedural success rates, increased periprocedural major adverse events, and unfavorable long-term clinical outcomes compared to non-calcific plaques. Adapted from the lithotripsy technology for treatment of nephrolithiasis, intravascular lithotripsy (IVL) is a new technique for treatment of severely calcific lesions that uses acoustic shock waves in a balloon-based system to induce fracture in the calcium deposits in order to facilitate luminal gain and stent expansion. Herein, we summarize the physics and characteristics of the currently available IVL system (Shockwave Medical, Santa Clara, CA), the clinical data on IVL use in the coronary arteries, and future directions for adoption of the technique in percutaneous coronary intervention.