IVL

INTRAVASCULAR LITHOTRIPSY

Vascular calcification (VC), particularly medial (Mönckeberg’s medial sclerosis) arterial calcification, is common in patients with diabetes mellitus and chronic kidney disease and is associated with increased cardiovascular morbidity and mortality.

Aging is a major cause of VC  and, from age 20–90 years, its incidence may increase by 30%.Age and hypertension were the most important risk factors for systemic calcific atherosclerosis.

Although lower extremity VC is commonly found in PAD and critical limb ischemia (CLI) atherosclerotic calcification  in either carotid, coronary, proximal and distal aorta or iliac vascular beds can be present in Asymptomatic patients too.

Chronic kidney disease (CKD) and diabetes mellitus (DM) are the leading causes of VC. In these disease states, there is an accumulation of calcium (Ca++) and phosphate (P) in arteries with mineral deposits in the intimal or medial layer of the vessel wall.

The presence of vascular calcification may interfere with the delivery of endovascular therapies, where it is responsible for suboptimal vessel expansion and increased risk of vascular complications including dissection and perforation, resulting in higher provisional stent rates and increased risk of suboptimal stent-related restenosis. Balloon angioplasty of “severely” calcified lesions is limited by early elastic recoil and poor acute and long-term outcomes.

Intravascular lithotripsy (IVL) utilizes multiple emitters mounted on a traditional angioplasty balloon catheter that provide pulsatile acoustic pressure energy to fracture superficial and deep calcium without affecting local soft tissues or liberating emboli, thereby serving as a novel vessel preparation option to improve luminal compliance and facilitate definitive endovascular treatment.

The IVL treatment arm demonstrated superior procedural success and primary patency compared to the Percutaneous Transluminal Angioplasty  and When treating heavily calcified PAD vessel preparation with IVL offers a more safe and predictable procedure than PTA while providing durable longer term vascular patency results with significantly reduced need for provisional stenting.