Intravascular lithotripsy: A novel option for severe calcification of coronary artery

BackgroundSevere coronary artery calcification is associated with low success rate of interventional operation, perioperative adverse cardiac events, and poor prognosis, which is a major problem faced by operators. The existing therapy methods all have inherent limitations, such as unsatisfactory balloon crossability, inadequate balloon dilation, and so on. The emergence of intravascular lithotripsy (IVL) has brought the dawn of the treatment of calcified lesions by using unfocused acoustic pressure waves to fracture calcification in situ. And IVL is the only technology capable of targeting deep calcification.HypothesisIVL may have great clinical application values and potential prospects.MethodBased on the existing clinical evidence of IVL and traditional treatment ways, this review discusses the safety and efficacy of IVL. Combined with clinical practice, the precautions and coping strategies of IVL are analyzed. And the review improves the management algorithm of coronary calcification.ResultsIVL has extremely high safety and effectiveness for severe coronary calcification compared with other ways, and structural improvements of IVL will further expand its value.ConclusionsThe emergence of IVL could set off a revolution in the treatment of coronary artery calcification. An algorithm for coronary calcification. CAG, coronary angiography; CaLADeN, calcium length, arc, vessel diameter, and nodule by IVUS; CVI, calcium volume index from OCT; IVL, intravascular lithotripsy; IVUS, intravascular ultrasound; NC, Noncompliant; NSE, nonslip element; OA, orbital atherectomy; OCT, optical coherence tomography; OPN, ultrahigh pressure noncompliant balloon; RA, rotational atherectomy.image