Shockwave IVL & Concentric Calcium

A sound success: Shockwave Intravascular Lithotripsy (IVL) cracks deep into the calcium wall, helping to overcome the limitations of traditional atherectomy ablation on concentric calcium.

Shockwave IVL for Coronary Artery Disease Shockwave IVL & Eccentric Calcium Shockwave IVL & Nodular Calcium Shockwave C2+
Digital rendering of cross-sectional view of blood vessel showing concentric calcification

Gain the Upper Hand Over Concentric Calcium with Shockwave IVL

Concentric calcium with an arc of greater than 270° can be difficult to treat through alternative calcium modification strategies. Shockwave IVL, on the other hand, has mechanistic advantages which create circumferential, longitudinal and transverse fractures throughout both superficial and deep calcium. 

ATHERECTOMY THERAPY:

SHOCKWAVE IVL THERAPY:

Illustration of intravascular lithotripsy (IVL) treatment on a calcified artery, showing both cross-sectional and longitudinal views

Shockwave IVL’s Effectiveness in Concentric Calcium 

In this concentric calcium case, large multi-plane and longitudinal calcium fractures were visualized post-Shockwave IVL treatment. 

  • Intravascular imaging cross-section showing concentric calcium

    Severe Calcific Stenosis

    OCT demonstrating severe calcific stenosis
  • Intravascular imaging cross-section within a calcified artery post-ivl

    Post IVL

    Following Shockwave IVL, two fractures (white arrows) are seen associated with luminal gain
  • Intravascular imaging cross-section showing stent deployment within an artery.

    Following Stent Deployment

    Fracture widening (markers) following stent deployment facilitates further luminal gain

OCT Analysis in Concentric Calcium Demonstrated Large Minimum Stent Areas and Stent Expansion Post-Shockwave IVL and Stenting 

Pre-IVL (N=66)
Max continuous calcium arc, °  360° 
Lesion length, mm  32.6 (24.0 to 39.6) 
Calcium length, mm  27.0 (18.8 to 34.0) 
Minimal lumen area, mm2*  1.97 (1.43 to 2.34) 
Area stenosis, %  73.07±12.49 

Post-stent at Max Calcium Site (N=66)
Area stenosis, %  −17.7 (−29.1 to 4.4) 
Stent area, mm2  8.09 (6.77 to 9.03) 
Stent expansion, %  102.0 (88.8 to 117.1) 
Acute area gain, mm2  4.70 (3.35 to 6.47) 
Calcium fracture  81.8% (54/66) 

Post-PCI Final Complications 
Severe dissection (D-F)  0.0% (0/66) 
Slow flow or no reflow  0.0% (0/66) 
Abrupt closure  0.0% (0/66) 
Perforation  0.0% (0/66) 

 

*MLA was never co-localized with the pre-IVL maximum calcification. 

1: Ali et al. Impact of Calcium Eccentricity on the Safety and Effectiveness of Coronary Intravascular Lithotripsy: Pooled Analysis From the Disrupt CAD Studies. Cir Interventions. 2023. 

Conclusions from the OCT Pooled Analysis in Concentric Lesions

  • The present individual patient data pooled analysis of 4 studies (N=262) represents the largest evaluation of Shockwave IVL by OCT

  • No serious angiographic complications were observed confirming the safety of Shockwave IVL for the treatment of severely calcified coronary lesions

  • OCT demonstrated extensive calcium fracture after Shockwave IVL treatment with excellent stent expansion of severely calcified lesions

  • Visible calcium fracture and calcium characteristics were not predictors of stent expansion following treatment with Shockwave IVL

Review the full OCT presentation: 

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See All Clinical Evidence
See All Clinical Evidence
  • DISRUPT CAD Pooled
    The largest systematic assessment of Shockwave coronary Intravascular Lithotripsy (IVL) to date based on individual patient data from DISRUPT CAD I–IV.
    Coronary IVL
  • DISRUPT CAD Pooled OCT Subgroup Analysis
    Individual patient data pooled from DISRUPT CAD I-IV to see Shockwave IVL outcomes, fracture analysis and stent expansion predictors.
    Coronary IVL
  • EMPOWER CAD
    The first prospective, female-only study of coronary interventions in complex calcific disease, in collaboration with female leaders.
    Coronary IVL

  • Shockwave IVL & Eccentric Calcium

    Learn how Shockwave IVL successfully modifies eccentric calcium. 

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  • Shockwave IVL & Nodular Calcium

    Learn how Shockwave IVL successfully modifies nodular calcium. 

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