Calcium Challenge – Tackling Rings, Nodules and Plates: How Can We Get More from Intravascular Lithotripsy Technology?

Calcific coronary artery disease presents unique challenges in achieving optimal stent deployment, which is crucial for long-term procedural success. Intravascular lithotripsy (IVL), introduced to the UK in 2018, has revolutionised the treatment of calcific lesions through its simplicity of use and ability to modify calcium safely and effectively. This expert opinion explores the evolution of IVL technology, its mechanism of action, and suggested refinement in its application based on the evidence and experience of the authors. Emphasis is placed on optimising IVL usage across various calcific scenarios, including concentric, nodular and eccentric calcium, and large bifurcations. Lessons from peripheral vascular studies, such as balloon oversizing strategies, are discussed to enhance the optimal usage of IVL in coronary interventions. By proposing new iterations in IVL usage, and emphasising its safety and efficacy, this article aims to refine the interventional community’s approach to tackling calcific coronary disease with IVL.