Principles of Intravascular Lithotripsy for Calcific Plaque Modification.

A significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds exhibit moderate to severe calcific plaques known to portend lower procedural success rates, increased peri-procedural adverse events, and unfavorable clinical outcomes compared with noncalcific plaques. Adapted from lithotripsy technology used for treatment of ureterorenal calculi, intravascular lithotripsy (IVL) is a novel technique for the treatment of severely calcific plaque lesions that uses acoustic shockwaves in a balloon-based delivery system. Shockwaves induce calcium fractures, which facilitate stent expansion and luminal gain. In this review, the authors summarize the physics, preclinical and clinical data on IVL use in the coronary and peripheral vasculature, and future directions of IVL in transcatheter cardiovascular therapies.

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Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr. Kereiakes is a consultant for SINO Medical Sciences Technologies, Boston Scientific, Elixir Medical, Svelte Medical Systems, Caliber Therapeutics/Orchestra Biomed, and Shockwave Medical; and is a stockholder in Ablative Solutions. Dr. Virmani has received grant, research, and clinical trial support from the National Institutes of Health, the Leducq Foundation, 480 Biomedical, 4C Medical, 4Tech, Abbott, Accumedical, Amgen, Biosensors, Boston Scientific, Canon USA, Cardiac Implants, Celonova, Claret Medical, Concept Medical, Cook, CSI, DuNing, Edwards Lifesciences, Emboline, Endotronix, Envision Scientific, Lutonix/Bard, Gateway, Lifetech, Limflo, MedAlliance, Medtronic, Mercator, Merrill, Microport Medical, Microvention, Mitralign, MitrAssist, NAMSA, Nanova, Neovasc, NIPRO, Novogate, Occulotech, OrbusNeich Medical, Phenox, Profusa, Protembis, Qool, ReCor Medical, Senseonics, Shockwave, Sinomed, Spectranetics, Surmodies, Terumo, Vesper, W.L. Gore, and Xeltis; and is a consultant for Abbott Vascular, Boston Scientific, Celenova, Cook Medical, CSI, Edwards Lifesciences, Bard BD, Medtronic, OrbusNeich Medical, ReCor Medical, SinoMedical Technology, Surmodics, Terumo, W.L. Gore, and Xeltis. Dr. Hokama is an employee of Shockwave Medical. Dr. Illindala is an employee of Shockwave Medical. Dr. Mena-Hurtado is a consultant for Abbott, Boston Scientific, Cook, Medtronic, Cardinal Health, and Optum Labs. Dr. Holden is a clinical investigator and medical advisory board member for Shockwave Medical. Dr. Hill reports fees and grant support from Abbott Vascular, Boston Scientific, Abiomed, and Shockwave Medical; and is a stockholder in Shockwave Medical. Dr. Lyden is a consultant to Boston Scientific, Abbott, Medtronic, Shockwave Medical, PQ Bypass, Intact, and Penumbra. Dr. Ali has received grants from the National Institutes of Health/National Heart, Lung, and Blood Institute, Abbott Vascular, and Cardiovascular Systems; has received personal fees from Amgen, AstraZeneca, and Boston Scientific; and holds equity in Shockwave Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.