Shockwave intravascular lithotripsy (IVL)-Advancement of Medical Technology in India
Shockwave intravascular lithotripsy (IVL) is a novel device that may be utilized in patients with calcified lesions. The technology gained European CE mark in May 2017 for coronary arteries. It currently has U.S. Food and Drug Administration (FDA) approval only for calified peripheral arteries, which it gained in June 2017. It is an innovative approach for treating calcified lesions that has the potential to allow interventional cardiologist tackle even the most challenging calcified lesions without serious complications experienced with traditional devices.
Calcified coronary lesions often cause suboptimal stent expansion, one of the biggest predictors of stent failure, potentially resulting in stent thrombosis and stent restenosis.1 Balloon angioplasty in heavily calcified lesions has a minimal effect on calcium modification. Luminal expansion is achieved by stretching and disruption on the non-calcified vessel wall, resulting in an increased risk of dissection.2 While traditional calcium modification devices like rotational atherectomy may have a role in treating concentric calcium, their role in eccentric calcium is unclear. Intravascular lithotripsy (IVL) (Shockwave Medical) is a newly available treatment for calcified coronary plaque prior to stent placement.
At low balloon pressure, lithotripsy electrodes inside the system generate pulsatile mechanical energy that disrupts the calcium at the target site and allows for the optimization of stent deployment and expansion. IVL may be a useful tool for interventional cardiologists as the aging population globally will have a higher prevalence of calcified lesions.