Shockwave Intravascular Lithotripsy for Calcified Coronary Lesions: First Real-World Experience

Background: Calcified coronary lesions often cause suboptimal stent expansion, which is one of the greatest predictors of adverse outcomes such as stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL) is a recently approved technique used in the treatment of heavily calcified coronary lesions. This study presents early real-world experience with the S-IVL device. Methods: All patients treated with S-IVL between October 2018 and January 2019 during their percutaneous coronary intervention (PCI) at the current centre were included. Results: During this period, there were 26 patients who underwent PCI and were treated with S-IVL prior to stent deployment (69% male; age, 72 ± 8 years). Indications for PCI were acute coronary syndrome (ACS) in 14 patients (54%), stable angina in 11 patients (42%), and PCI before transcatheter aortic valve implantation in one patient (4%). Of the ACS cases who underwent PCI with S-IVL, 71% were to the perceived ACS culprit lesion during the index procedure, while 29% were staged PCIs to severe non-culprit lesions. Upfront S-IVL usage occurred in 58% of cases; the rest were bail-out procedures due to suboptimal initial balloon predilation. S-IVL was most commonly used in the left anterior descending coronary artery (50%), with 1.3 ± 0.5 stents implanted/target vessel. Angiographic success (<20% residual stenosis) occurred in all cases, with no procedural complications. Conclusion: S-IVL appears to be a useful modality in coronary calcium modification to optimise stent expansion. This device obviates the need for more complex lesion preparation strategies such as rotational atherectomy. Further study is warranted to compare different calcium modification devices with conventional balloon angioplasty.