• Coronary Stenosis

Extracorporeal shock wave lithotripsy (ESWL) is standard of care for the treatment of renal calculi. Fracturing large renal calculi using acoustic energy allows them to be safely passed as smaller fragments therefore avoiding surgical treatment. The adaption of ESWL to the vascular space, termed intravascular lithotripsy (IVL), could be said to have a similar goal and has sparked renewed interest in the percutaneous treatment of calcified coronary artery disease (CCAD). The mechanism of action, acoustic waveforms which selectively target calcium, is novel within the vascular space. Yet, crucially, as it is delivered via a balloon platform, it feels familiar.

The prospective DISRUPT-CAD trials established IVL’s safety and efficacy in treating CCAD.1 However, as is typical with trials designed for regulatory approval, these studies were conducted in elective patients with restrictive inclusion criteria. IVL penetrance and use in off-label indications has exponentially increased since the device’s approval. Real-world registries are therefore important to explore the use of IVL within extended use criteria.

This retrospective study by van Oort and colleagues2 included patients from a multicentre IVL registry from seven European centres between 2019 and 2024 and included core lab analysis of angiographic and intracoronary imaging (ICI) data. It provides insights into contemporary IVL utilisation patterns, safety and efficacy.

The findings align with the DISRUPT-CAD data, but crucially extend IVL validation across a broader population, which included higher risk presentations (acute …