JACC Cardiovasc Interv. 2026 Oct 26;19(20):2679-2690. doi: 10.1016/j.jcin.2026.07.027.
ABSTRACT
BACKGROUND: Intravascular lithotripsy (IVL) uses ultrasonic acoustic pressure waves to modify calcification to enable optimal balloon and stent expansion in calcified lesions. However, the dose-response relationship for creating fractures within calcified lesions of different calcium morphologies is unknown.
OBJECTIVES: The aim of this study was to evaluate the dose-dependent effects of IVL on calcium fracture overall and in the setting of calcification arc <180° vs ≥180°.
METHODS: Micro-computed tomography images were acquired before and after 10, 20, 40, 60, 80, and 120 pulses of IVL treatment (Shockwave Medical) in an ex vivo study of 5 cadaveric human hearts (15 coronary lesions). A total of 30 cross-sections of micro-computed tomography (2 sections per lesion) were analyzed for this study.
RESULTS: Cumulative fracture occurrence increased progressively with the number of IVL pulses delivered, with fractures observed in 33% of sections after 10 pulses, 50% after 40 pulses, and 60% after 120 pulses. Calcification arc ≥180° exhibited a higher fracture occurrence compared with arc <180° (P = 0.028). After adjustment for pulse number, calcification arc ≥180° was associated with significantly higher fracture counts compared with arc <180° (rate ratio = 6.1, P = 0.003).
CONCLUSIONS: Fracture occurrence following IVL increased with cumulative pulse delivery and differed significantly according to calcification concentricity. Calcification arc ≥180° demonstrated a higher and earlier likelihood of fracture occurrence than arc <180°, independent of pulse number. These findings establish a clear dose-dependent relationship between IVL pulse delivery and fracture formation and highlight calcification concentricity as a key determinant of fracture response.
PMID:42933909 | DOI:10.1016/j.jcin.2026.07.027