Case submitted by Nelson Bernardo, MD, MedStar Health

Summary: Patient was considered high surgical risk due to severity of calcium and involvement of profunda. Shockwave IVL treatment of common femoral artery (CFA) and proximal superficial femoral artery (SFA), followed by treatment of profunda with the same device. Final result shows no dissection, perforation, emboli, need for additional devices and full resolution of symptoms.

Case submitted by Marianne Brodmann, MD, University of Graz

Summary: Proximal total occlusion and distal sub-total occlusion of popliteal artery. Severe calcification throughout. 4.5 mm x 60 mm Shockwave IVL delivered distally, followed by 5.5 mm x 60 mm IVL proximally. Final result shows <30% residual with IVL alone, no complications and no implants.

Case submitted by Bill Miller, MD, Medical Center of the Rockies

Summary: Severely calcified superficial femoral artery (SFA) and popliteal disease extending from proximal SFA to Hunter’s Canal. One Shockwave IVL device used to treat entire segment with low residual, no complications and no further device intervention.

Case submitted by Sarang Mangalmurti, MD, Mainline Health

Summary: Severe concentric calcification of anterior tibial artery with 100% occlusion. 3.0 mm x 40 mm Shockwave IVL delivered into AT with no difficulty. >12 cm of AT treated. <20% residual stenosis followed stand-alone IVL with no complications.

Case submitted by Roger Gammon, MD, Heart Hospital of Austin

Summary: Extensive trifurcation calcification involving anterior tibial and tibioperoneal trunk. Multiple previous failed interventions. Prior to Shockwave IVL, multiple failed percutaneous transluminal angioplasty (PTA) and cutting balloons used in the same procedure. 4.0 mm x 60 mm Shockwave IVL delivered across PT ostium and three cycles delivered. Same catheter moved to AT ostium and three cycles delivered. Final result shows resolution of stenosis and good flow.

Case submitted by Roberto Ferraresi, MD, Humanitas Gavazzeni

Summary: CLTI patient (Rutherford 5) with foot ulceration. Diagnostic angiogram shows near-occlusion of distal AT. 2.5 mm percutaneous transluminal angioplasty (PTA) of AT and dorsalis pedia attempted with near-immediate recoil and unsatisfactory result. 2.5 mm x 40 mm Shockwave IVL introduced into distal AT. Post-IVL angiogram shows resolution of stenosis with good distal flow into dorsalis pedis and no complications.

Case submitted by Jean Fajadet and Bruno Farah, Clinique Pasteur

Summary: Severely calcified distal left main and proximal left anterior descending (LAD) lesion; operators were hesitant to use rota; Shockwave IVL advanced with no pre-dilation required; 3.5 x12 mm IVL treatment performed and balloon waist resolved after 20 pulses; final result of widely patent artery with TIMI 3 flow post-stent (3.5 mm) with 4.5 mm NC post-dil.

Case submitted by Javier Escaned, San Carlos Hospital

Summary: Severely calcified mid-left anterior descending artery (LAD) involving septal branch; patient was high-bleeding risk and IABP used for hemodynamic support; operators wanted to avoid distal embolization for this patient and chose Shockwave IVL; 3.0 mm IVL catheter used across diffuse calcified disease; significant fractures seen under OCT in multiple planes; circumferential and well-apposed 3.0 x 32 mm drug-eluting stent (DES).

Case submitted by Javier Escaned, San Carlos Hospital

Summary: Highly angulated left circumflex artery (LCX) with lesions proximal and distal; OCT wouldn’t cross either lesion; guideliner-assisted Shockwave IVL catheter delivery followed by successful IVL therapy; the case was completed with easy deployment of two long drug-eluting stents (DES).

Case submitted by Jonathan Hill, King’s College

Summary: Multi-lesion right coronary artery (RCA); couldn’t advance guideliner to distal lesion despite predilation; advanced 3.5 mm Shockwave IVL catheter as far as possible (1); delivered one cycle (10 pulses) and vessel opened; pulled back to the ostium (2) and vessel opened after one cycle (10 pulses); advanced to distal lesion (3) and vessel opened after one cycle (10 pulses); easily delivered 80 mm of drug-eluting stent (DES).