Intravascular lithotripsy for the treatment of calcified coronary artery disease: A case series

Objectives: Severe coronary artery calcification poses major challenges to percutaneous coronary intervention, often limiting stent expansion and procedural success. The Sonico-CX intravascular lithotripsy (IVL) system is a novel calcium-modification device designed to fracture calcified plaques using acoustic shockwaves. Methods: We present a case series of 21 patients with balloon-undilatable, severely calcified lesions treated with this new IVL system. All procedures were performed by experienced interventional cardiologists between April and August 2024. Adjunctive noncompliant and scoring balloons were used, and 4 cases required rotational atherectomy to facilitate IVL delivery. Results: IVL achieved a high procedural success rate (90.5%) with no intraprocedural complications or inhospital and 30-day major adverse cardiovascular events. The use of IVL enabled effective drug-coated balloon therapy in 85.7% of cases, reducing the need for stent implantation. Conclusions: This case series highlights the safety and efficacy of a novel IVL system and its potential to simplify complex percutaneous coronary intervention by providing effective lesion preparation in heavily calcified coronary disease.