Intravascular lithotripsy (IVL) is a novel approach for treatment of severely calcified peripheral lesions. It uses acoustic shockwaves that interact with arterial calcified plaques to induce fracture facilitating vessel expansion and therefore stent implantation if necessary.

In order to study the contribution of this new technique, we have applied it to various highly calcified arterial locations.

IVL cracks medial and intimal calcium utilizing lithotripsy emitters mounted on a balloon catheter and delivering pulsatile sonic pressure waves (50 bars) to modify vessel compliance. Up to 300 pulsations could be applied at the site of the calcification to obtain the full expansion of the balloon catheter. Five to 7mm IVL balloon catheters are selected according to size of the native vessel.

Twenty-six pts were treated at first by IVL for concentric or eccentric heavily calcified stenosis followed by stent implantation (25 pts) or complementary drug coated balloon (1 pt). Carotid artery stenosis: 7 pts, subclavian artery stenosis: 2 pts, abdominal aorta stenosis & occlusion: 3 pts, common iliac artery: 2 pts, common femoral stenosis & occlusion: 7 pts, femoro-popliteal stenosis: 5 pts.

The immediate results and after one month were excellent: no extensive dissection, no perforation or vessel rupture, no residual stenosis after stent placement, no delayed occlusion. Longer-term follow-up will be available at the time of the congress.

In our experience, IVL is a promising new technique for the treatment of highly calcified peripheral arterial lesions. It facilitates the deployment of stents to obtain an optimal vessel lumen. Progresses are to be obtained in the development of new IVL balloons of larger diameters and different lengths. Financial support for this new technique seems highly necessary in the near future.