Shockwave therapy for coronary calcification: the evolving role of intravascular lithotripsy in coronary interventions

Severely calcified coronary lesions represent a significant challenge during percutaneous coronary interventions (PCI), often limiting optimal stent deployment and increasing the risk of procedural complications. Intravascular lithotripsy (IVL) is an emerging technology designed to modify calcified plaques through the application of acoustic shockwaves, offering a safer and more controlled alternative to traditional atherectomy. Aim of the Study: This study aims to provide a comprehensive overview of the intravascular lithotripsy (IVL) technique, its mechanism of action, indications, and contraindications. Additionally, it evaluates the procedural efficacy, safety profile, and clinical outcomes of IVL based on current clinical trial data and real-world experience. Material and Methods: A narrative review was conducted, incorporating findings from major clinical trials (Disrupt CAD I–IV) and observational registries, with a focus on procedural success, complication rates, and major adverse cardiac events (MACE). The review includes comparative analysis of IVL outcomes in de novo lesions, in-stent restenosis (ISR), chronic total occlusions (CTO), and complex anatomical scenarios. Conclusions: IVL is a highly effective and safe modality for the modification of calcified coronary lesions. It consistently demonstrates procedural success rates exceeding 90%, with a low incidence of complications such as perforation or dissection. Clinical efficacy is sustained in both short- and long-term follow-up, with low MACE rates observed across studies. IVL is particularly valuable in cases resistant to conventional techniques. However, limitations related to cost, access, and certain patient populations necessitate further randomized studies to establish its role as a standard of care.