IVL To Facilitate TAVI Access | Shockwave Medical

Treating a Calcified Popliteal CTO With No Complications

This was a 72 year-old female patient presenting with lifestyle limiting claudication and more recently getting rest pain at night with symptoms being worse in the left leg. The patient is a former smoker, has diabetes and CKD. Invasive angiography of the left leg showed a chronic total occlusion in the P1 and P2 segments of the popliteal with no iliac disease and three vessel runoff to feet. The CTO was crossed and a 3.0mm POBA was used for the initial dilation. Then a 5.0mm Shockwave M⁵⁺ was used along the calcified segments, finishing with a DCB. IVUS imaging of calcified segments showed no dissections and good vessel expansion.

Pre-Treatment Angiogram

Diameter stenosis = 100%

Post Pre-Dilation

3mm POBA

Post-IVL

5 x 60mm Shockwave M⁵⁺

Final Angiogram

No dissections, perforations, or stent Residual stenosis = 10%

Case courtesy of Dr. Anand Prasad

IVL Shows Consistent safety and effectiveness in DISRUPT PAD III Randomized Control Trial & DISRUPT PAD III Observational Study

EXCEPTIONAL SAFETY PROFILE

PROVEN EFFECTIVE CALCIUM MODIFICATION

¹Tepe et al., J Am Coll Cardiol Intv 2021

²E. Armstrong, VIVA Late Breaking Clinical Trial 2022

PRESERVED OPTIONS¹

IVL maintains control of the procedure by minimizing complications such as dissections, embolization, and perforations. IVL significantly reduces the need for bailout stents, preserving future treatment options.

REDUCED DISSECTIONS

LOW COMPLICATIONS

0% embolization, perforation, thrombus, and no flow

REDUCED BAILOUT STENTING

IVL 75% reduction in bailout stenting bar graph

¹Tepe et al., J Am Coll Cardiol Intv 2021

Excellent Long-Term Results¹

IVL has demonstrated excellent patency out to two years in a severely calcified patient population.

Primary Patency^*

^*Primary Patency defined as freedom from provisional stenting at index procedure, freedom from clinically-driven target lesion revascularization, and freedom from restenosis determined by duplex ultrasound

¹Tepe et al., J Am Coll Cardiol Intv 2021

CME: Tackling Calcium in the SFA/Popliteal: What’s in your toolbox?

After participating in this activity, learners should be better able to:

Identify calcium in the superficial femoral and popliteal artery
Develop an algorithm for treatment based on lesion type
Utilize intravascular lithotripsy and other available tools to treat calcium in the SFA/Pop