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.
1Tepe et al., J Am Coll Cardiol Intv 2021
2E. Armstrong, VIVA Late Breaking Clinical Trial 2022
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.
1Tepe et al., J Am Coll Cardiol Intv 2021
IVL has demonstrated excellent patency out to two years in a severely calcified patient population.
*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
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But, right now we're in the early phases of the R&D program. In the meantime, don't miss the IVL application that heart teams are embracing already — maintaining transfemoral TAVR access through heavily calcified iliacs by using IVL.
