In this video, Dr. Venita Chandra shares 12-month outcomes from the DISRUPT BTK II trial, a prospective study evaluating IVL in a cohort of 250 patients, 200 of which have chronic limb-threatening ischemia (CLTI)—a population that is often excluded from clinical studies due to disease complexity.

The presentation highlights key clinical findings, including freedom from low intervention rates, low major amputation rates, and meaningful improvements in quality of life and wound healing. These outcomes demonstrate durable results at 12 months in severely calcified, below-the-knee disease.

Together, the data shown in this video support IVL as a frontline calcium-modification strategy* and an important part of the treatment algorithm for CLTI, reinforcing its role in improving patient outcomes and reducing amputation risk.

Watch now to learn more about how IVL is impacting outcomes in patients with CLTI.

Dr. Venita Chandra is a paid consultant of Shockwave Medical.

*Frontline Strategy: The approach of utilizing IVL as the primary treatment method, implemented without the use of atherectomy. This strategy is backed by the BTK II data based on the percentage of procedures involving pre-dilatation and post-dilatation, as well as the proportion of stenting performed. Our BTK II data indicates a notably low usage of both pre-dilatation and post-stenting in these cases.

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.

In this video, Dr. Michael Siah from UT Southwestern in Dallas presents a complex limb-salvage case involving an 84-year-old patient with critical limb-threatening ischemia and peripheral arterial disease. The patient had significant comorbidities, including end-stage renal disease, heart failure, lupus, and a non-healing right foot ulcer, along with prior deep vein arterialization on the contralateral limb. Imaging revealed severe disease spanning the superficial femoral artery, tibial vessels, and below-the-ankle circulation, including a heavily calcified dorsalis pedis chronic total occlusion that proved difficult to treat with standard endovascular tools.

Dr. Siah walks through his strategy, detailing challenges with access, device delivery, and lesion crossing despite balloon angioplasty and intravascular lithotripsy (IVL). When conventional low-profile balloons and orbital atherectomy were unsuccessful due to delivery limitations, he turned to the Shockwave Javelin catheter where its use significantly modified the plaque and vessel compliance. This effect allowed a previously unsuccessful balloon to cross and treat the lesion, ultimately restoring inline flow to the forefoot.

The successful outcome—near-complete wound healing at six weeks and preservation of a functional transmetatarsal amputation—underscores the importance of patience, adaptability, and thoughtful tool selection when treating advanced limb ischemia.

Dr. Siah is a paid consultant of Shockwave Medical. Views expressed are those of the presenters and not necessarily those of Shockwave IVL.

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. Please contact your local Shockwave representative for specific country availability.

Join Dr. Ziad Ali, Dr. Jai Khatri, Dr. Aloke Finn and Professor James Spratt as they discuss coronary artery calcification and the importance of understanding calcium morphologies in guiding treatment during percutaneous coronary intervention (PCI).

During the webinar, the Faculty review data from a recent cadaver-based comparative study that evaluated Intravascular Lithotripsy (IVL) alongside cutting balloons and ultra–high-pressure balloons using micro-CT, OCT, and histology. The study included calcium modification data from key calcium types—concentric, eccentric, and nodular calcium —and they explain why accurate assessment of calcium morphology is essential for selecting safe and effective treatment options. Findings from the study demonstrated that IVL consistently produces calcium fractures in most lesions, while minimizing vessel wall injury, whereas high-pressure balloons frequently damaged the vessel wall with less consistent fracture. An important consideration given the association between medial injury and adverse long-term outcomes.

Additionally, the Faculty also discuss Shockwave IVL’s mechanism of action, highlighting how ultrasonic pressure waves selectively fracture calcium based on acoustic impedance while preserving soft tissue. Clinical case examples illustrate the role of IVL in complex and high-risk lesions where procedural safety is critical, reinforcing IVL’s value as a low-risk and effective approach to calcium modification across a range of coronary anatomies.

Drs. Ali, Khatri, and Finn, and Professor Spratt are paid consultants of Shockwave Medical. Views expressed are those of the presenters and not necessarily those of Shockwave IVL.

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. Please contact your local Shockwave representative for specific country availability.

Watch Dr. Paul Foley and Dr. Mazin Foteh for a virtual case review, moderated by Dr. Leigh Ann O’Banion, as they discuss two of their challenging below-the-knee (BTK) cases using Shockwave Intravascular Lithotripsy (IVL). The webinar showcases detailed case reviews, including the use of innovative technology such as Shockwave Javelin, highlighting its role in modifying challenging calcified lesions.

In this session, Dr. Foley presents a compelling case of an elderly male with limb-threatening ischemia, non-healing ulcers, and extensive calcified arterial disease. The discussion covers preoperative planning, including the importance of duplex ultrasound, CTA imaging, and strategic access approaches—antegrade versus pedal access—to optimize procedural success. The team emphasizes the critical role of intravascular ultrasound (IVUS) in accurately sizing vessels and characterizing plaque, which guides effective treatment choices.

Throughout the webinar, the panel explores various crossing techniques, wire escalation strategies, and the nuances of delivering energy with devices like Shockwave Javelin. They compare different atherectomy and lithotripsy tools, debating the merits of focal versus circumferential calcium modification, and discuss how these technologies can improve vessel compliance and blood flow. The importance of multidisciplinary collaboration, including insights from interventional cardiology and radiology, is also underscored as vital to advancing limb salvage efforts.

Drs. O’Banion, Foley, and Foteh are paid consultants of Shockwave Medical. Views expressed are those of the presenters and not necessarily those of Shockwave IVL.

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. Please contact your local Shockwave representative for specific country availability.

A recently published cadaveric study compares the frequency and patterns of calcium fracture and medial injury based on the mechanism of action (MOA) of advanced calcified lesion preparation strategies.

17 cadaveric calcified lesions were randomized to one of three treatment arms of Intravascular Lithotripsy (IVL; Shockwave C2+), cutting balloons (CB; Wolverine™ Boston Scientific) and ultra-high pressure balloons (UHB; OPN NC SIS Medical). Frequency of calcium fracture and presence of medial injury – which potentially negatively affects long-term clinical outcomes due to increased neointimal thickness, higher inflammatory cell count and in-stent restenosis^1,2 – were identified using gold-standard techniques of micro-CT and histology.

Shockwave C2+ produced the most calcium fracture with the least amount of medial injury by lesion and across concentric and eccentric calcium arcs. Within histological sections with concentric calcium, fractures produced by Wolverine™ and OPN NC were mostly associated with medial injury. No calcium fracture was identified for UHB within eccentric calcium.

Learn more by downloading the one-page clinical summary and viewing the video below for a roundtable discussion between the study’s principal investigators, Drs. Ziad Ali and Aloke Finn, moderated by Shockwave Medical Chief Medical Officer, Dr. Nick West.

Download Clinical Summary

Sekimoto, T et al. Comparison of Vascular Injury From Intravascular Lithotripsy, Cutting, or Ultra-High-Pressure Balloons During Coronary Calcium Modification. J Am Coll Cardiol Intv. 2025 Sep, 18 (17) 2093-2104. Cadaveric study. May not be indicative of actual clinical use.

1: Farb A, et al., Pathology of acute and chronic coronary stenting in humans. Circulation. 1999 Jan 5-12;99(1):44-52.
2: Schwartz RS, et al., Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol. 1992 Feb;19(2):267-74.

Drs. Ziad Ali and Aloke Finn are paid consultants of Shockwave Medical. Views expressed are those of the presenters and not necessarily those of Shockwave IVL.

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. Please contact your local Shockwave representative for specific country availability.