Raising the Stakes: A Paradigm Shift in BTK Calcium Solutions
This recorded webinar features an in‑depth, case‑based discussion focused on the treatment of heavily calcified below‑the‑knee (BTK) disease in patients with peripheral artery disease (PAD) and chronic limb‑threatening ischemia (CLTI). The session is moderated by Misty Humphries, MD, MAS, vascular surgeon at UC Davis Medical Center in Sacramento, CA, and includes expert faculty Venita Chandra, MD of Stanford University (Stanford, CA) and Leigh Ann O’Banion, MD of UCSF Fresno (Fresno, CA).
Dr. Humphries opens the webinar with an overview of the paradigm shift in BTK calcium management, highlighting the clinical challenges posed by diffuse, medial calcification, vessel recoil, and small vessel diameter in CLTI patients. She reviews best practices for intravascular lithotripsy (IVL), emphasizing the importance of intravascular ultrasound (IVUS)‑guided sizing, appropriate balloon oversizing relative to reference vessel diameter, and low‑pressure inflation to optimize calcium fracture and luminal gain while maintaining a strong safety profile. Technical features and use cases for Shockwave E8 and the Javelin forward‑emitting IVL catheter are also discussed.
Dr. Chandra reviews outcomes from the FORWARD study and new 12‑month data from the DISRUPT BTK II trial. She highlights the real‑world nature of these studies, which include patients with severe calcification, chronic total occlusions, diabetes, and end‑stage renal disease. Key findings discussed include low angiographic complication rates, meaningful reductions in diameter stenosis, favorable patency and freedom‑from‑TLR outcomes, high freedom from major amputation, and improvements in Rutherford classification, wound healing, and quality‑of‑life metrics.
Dr. O’Banion concludes the program by presenting real‑world cases that illustrate access planning, lesion crossing strategies, and treatment of diffuse tibial and pedal disease. Her cases demonstrate practical use of IVL technologies to modify calcified vessels, restore inline flow to wound‑related angiosomes, and achieve limb salvage without the need for stenting or surgical bypass in selected patients.
Throughout the discussion, the faculty emphasize multidisciplinary limb‑salvage decision‑making, thoughtful device selection, and the evolving role of IVL in treating complex BTK disease.
Learn more about DISRUPT BTK II here.
Drs. Humphries, Chandra, and O’Banion are paid consultants for 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.
