In this video series, Drs. Suzanne Baron, Kevin Croce and Nieves Gonzalo share their experiences with the Shockwave C2+ coronary Intravascular Lithotripsy (IVL) catheter in treating female patients with calcified coronary artery disease (CAD).

EMPOWER CAD is a prospective, multi-center, single-arm, female-only, all-comers study to generate real-world clinical evidence associated with coronary IVL.

Complex PCI in Women

Dr. Suzanne Baron outlines the growing need to EMPOWER, highlighting the studies that detail the discrepancies in percutaneous coronary interventions (PCI) between females and males.

Consistency Across the Sexes: IVL is Safe & Effective in Modifying Nodular Calcium in Men & Women¹

Case courtesy of Dr. Kevin Croce, Brigham and Women’s Hospital

Nodular calcium poses a big clinical problem that is predominantly represented in female patients. Calcified nodules have worse long-term outcomes than any other presentation of calcium. Shockwave IVL’s unique mechanism of action has proven to have a safer, more effective outcome when modifying nodular calcium compared to other atherectomy devices.²

Dr. Kevin Croce’s patient presented with a challenging tortuous nodular calcified lesion in the right coronary artery. After being unsuccessful in passing equipment through the lesion, a 1.5 Rota burr passed through the lesion. A post-atherectomy IVUS showed that rotational atherectomy supplied minimal benefit in modifying the calcium. A Shockwave IVL catheter was used and proved on IVUS to have a significant impact on the nodular calcium. Once the right coronary artery was fixed the left circumflex artery showed signs of nodular calcium on OCT. A Shockwave C2+ IVL catheter was used to successfully treat the nodular calcium safely and effectively. IVL has shown consistent MSA and stent expansion despite the presence of nodular calcium.

Consistent Results Regardless of Complex Anatomy

Case courtesy of Dr. Nieves Gonzalo, Clinico San Carlos University Hospital in Madrid

The main challenges for calcific lesion treatment in women are related with vessel size and tortuosity.³ Dr. Nieves Gonzalo’s patient presented with both challenges in the left anterior descending artery and the circumflex artery. After visualizing how severe the calcium was in both arteries, a 2.5 Shockwave C2+ catheter was used to modify the calcium. IVL has proven to be impactful and safe for the treatment of calcific coronary disease in females.

The physicians featured are paid consultants for Shockwave Medical.

1: Hill, J, Kereiakes, D, Shlofmitz, R. et al. Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Artery Disease. JACC. 2020 Dec, 76 (22) 2635-2646. https://doi.org/10.1016/j.jacc.2020.09.603.
2: Ali ZA, Shin D, Singh M, Malik S, Sakai K, Honton B, Kereiakes DJ, Hill JM, Saito S, Mario CD, Gonzalo N, Riley RF, Maehara A, Matsumura M, Hokama J, West NEJ, Stone GW, Shlofmitz RA. Outcomes of coronary intravascular lithotripsy for the treatment of calcified nodules: a pooled analysis of the Disrupt CAD studies. EuroIntervention. 2024 Dec 2;20(23):e1454-e1464. doi: 10.4244/EIJ-D-24-00282. PMID: 39618263; PMCID: PMC11586657.
3: Equity in Modifying Plaque of Women With Undertreated Calcified Coronary Artery Disease: Design and Rationale of EMPOWER CAD study McEntegart, Margaret et al. Journal of the Society for Cardiovascular Angiography & Interventions, Volume 3, Issue 11, 102289.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Robert Riley (Director, Interventional Cardiology Overlake Medical Center & Clinics, WA) shares his thoughts on incorporating Intravascular Lithotripsy (IVL) into coronary clinical practice in under three minutes.

Dr. Riley is a paid consultant of Shockwave Medical.

Views expressed are those of the authors and not necessarily those of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Kumar Madassery, MD, FSIR (Associate Professor, Vascular Interventional Radiology Director, Peripheral Vascular Interventions & CLTI Limb Preservation Program Rush University Medical Center, Chicago IL Rush Oak Park Wound Care Center & Hospital, Oak Park IL) shares his perspective on the impact of incorporating Intravascular Lithotripsy (IVL) in peripheral artery disease (PAD) in under four minutes.

In this discussion, Dr. Peter Soukas and Dr. Sameh Sayfo introduce Shockwave E8, the new peripheral IVL workhorse. They review cases and explore the benefits Shockwave E8 has to offer.

The first case features an 84-year-old patient with a non-healing wound and severely calcified below-the-knee arteries. Using E8’s longer working length and 400 pulses, they achieved significant acute lumen gain with minimal vessel trauma, demonstrating the device’s ability to navigate challenging anatomy and effectively modify calcified lesions.

The second case involves a 75-year-old patient with a sharp-angled anterior tibial artery lesion that had previously been deemed untreatable due to wire escalation failure. With Shockwave E8’s enhanced deliverability and 45 cm of hydrophilic coating, they successfully crossed the lesion and delivered therapy, restoring blood flow.

Dr. Soukas and Dr. Sayfo are paid consultants of Shockwave Medical.

Introducing Shockwave Javelin, the first-of-its-kind Forward IVL Platform for the treatment of difficult-to-cross lesions. Dr. Paul Foley and Dr. Leigh Ann O’Banion discuss what you need to know about Shockwave Javelin, cases, and best practices. Recorded March 2025.

Dr. Foley and Dr. O’Banion are paid consultants of Shockwave Medical.

Introducing Shockwave Javelin, the first-of-its-kind Forward IVL Platform for the treatment of difficult-to-cross lesions. Dr. John Corl and Dr. John Winscott discuss what you need to know about Shockwave Javelin, cases, and best practices. Recorded March 2025.

Dr. Corl and Dr. Winscott are paid consultants of Shockwave Medical.

In this VIVA 2024 interview, Dr. Nick West, Chief Medical Officer of Shockwave Medical, moderates a discussion on the DISRUPT BTK II acute and 30-day outcomes with the two co-principal investigators of the study, Dr. Armstrong, Interventional Cardiologist and Medical Director at Adventist Heart & Vascular Institute, and Dr. Venita Chandra, Vascular Surgeon and Clinical Professor at Stanford Health Care.

Watch now to learn more about the study’s significance, particularly in addressing an understudied area—below-the-knee (BTK) disease in patients with critical limb-threatening ischemia (CLTI). The study includes high-risk patients with heavy calcification who are often excluded from similar trials.

The 30-day results show promising outcomes, with low Major Adverse Limb Events (MALEs) and no mortality. A majority of patients experienced a substantial reduction in stenosis, with more than 90% achieving less than 50% residual stenosis and approximately 75% reaching less than 30% residual stenosis—all with a low stent rate (less than 5%) and low angiographic complications (1.0% at Final). Additionally, early wound healing signals were observed, and a mean improvement in Vascular Quality of Life scores within 30 days. The investigators are particularly excited about the upcoming six-month and one-year data, which will provide more insight into long-term wound healing and vessel patency.

Chandra V, Lansky AJ, Sayfo S, et al. Thirty-Day Outcomes from the Disrupt PAD BTK II Study of the Shockwave Intravascular Lithotripsy System for Treatment of Calcified Below-the-Knee Peripheral Arterial Disease. Journal of Vascular Surgery. Published online November 12, 2024. doi:10.1016/j.jvs.2024.11.003.

Dr. Armstrong and Dr. Venita Chandra are paid consultants of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Join Dr. Nick West, Chief Medical Officer of Shockwave Medical, Professor Andrew Holder, Auckland City Hospital, New Zealand, and Dr. Raghuram Lakshminarayan, Hull Royal Infirmary, UK, as they discuss the DISRUPT BTK II acute outcomes data at CIRSE 2024.

This discussion focuses on the procedural outcomes of the DISRUPT BTK II trial which studied the treatment of Intravascular Lithotripsy (IVL) for calcified below-the-knee (BTK) arterial disease. The study, which is the largest of its kind with 250 patients, focuses on treating severely calcified lesions in a complex patient population, including a high percentage of patients with diabetes and those with renal impairment. The findings highlight IVL’s strong safety profile and efficacy, with a low rate of angiographic complications and a high success rate in achieving significant luminal gain without the need for stenting in most cases.

The experts conclude that these results validate IVL’s role in BTK interventions and may encourage its broader adoption, particularly with the introduction of new IVL catheter technologies for endovascular treatments.

Chandra V, Lansky AJ, Sayfo S, et al. Thirty-Day Outcomes from the Disrupt PAD BTK II Study of the Shockwave Intravascular Lithotripsy System for Treatment of Calcified Below-the-Knee Peripheral Arterial Disease. Journal of Vascular Surgery. Published online November 12, 2024. doi:10.1016/j.jvs.2024.11.003.

Professor Andrew Holder and Dr. Raghuram Lakshminarayan are paid consultants of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Ankur Lodha (Interventional Cardiologist Cardiovascular, Institute of the South, LA) shares unique coronary Intravascular Lithotripsy (IVL) applications in under two minutes.

Dr. Lodha is a paid consultant of Shockwave Medical.

Views expressed are those of the authors and not necessarily those of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Kumar Madassery, MD, FSIR (Associate Professor, Vascular Interventional Radiology Director, Peripheral Vascular Interventions & CLTI Limb Preservation Program Rush University Medical Center, Chicago IL Rush Oak Park Wound Care Center & Hospital, Oak Park IL) shares his peripheral Intravascular Lithotripsy (IVL) best practices in under four minutes.