Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified cor...

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Bibliographic Details
Published in:Angiology 2020-09, Vol.71 (8), p.677-688
Main Authors: Kassimis, George, Didagelos, Matthaios, De Maria, Giovanni Luigi, Kontogiannis, Nestoras, Karamasis, Grigoris V., Katsikis, Athanasios, Sularz, Agata, Karvounis, Haralambos, Kanonidis, Ioannis, Krokidis, Miltiadis, Ziakas, Antonios, Banning, Adrian P.
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary - adverse effects
Angioplasty, Balloon, Coronary - instrumentation
Cardiac Catheters
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - therapy
Humans
Lithotripsy - adverse effects
Lithotripsy - instrumentation
Risk Factors
Severity of Illness Index
Stents
Treatment Outcome
Vascular Calcification - diagnostic imaging
Vascular Calcification - therapy
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Summary:Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.
ISSN:0003-3197
1940-1574
DOI:10.1177/0003319720932455