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Intravascular Lithotripsy — EECC MCQ

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HardCoronary Artery DiseaseIntravascular LithotripsyEECC

A 72-year-old man undergoes PCI to a severely calcified proximal LAD. Despite high-pressure non-compliant balloon inflation, the stent cannot be fully expanded (minimum stent area 3.2 mm²). What calcium modification technique should be considered?

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Correct answer: D — Intravascular lithotripsy (IVL) — delivers pulsatile sonic pressure waves to fracture intimal and medial calcium, allowing vessel compliance and stent expansion

Intravascular lithotripsy (IVL, Shockwave) is a novel calcium modification technique that delivers pulsatile sonic pressure waves (similar to renal lithotripsy) via a balloon catheter, fracturing both intimal and deep medial calcium without damaging soft tissue. It has emerged as a first-line approach for severely calcified coronary lesions, alongside rotational atherectomy (RA) and orbital atherectomy (OA). The DISRUPT CAD III/IV trials demonstrated high procedural success and safety. The 2024 ESC CCS Guidelines recommend calcium modification with IVL, RA, or OA when calcification prevents adequate stent delivery or expansion. IVL has the advantage of treating both superficial and deep calcium.

Reference: ESC (2024): CCS Guidelines; DISRUPT CAD Trials