Severe 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.
Based 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.
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.