Peripheral IVL linked to key benefits over atherectomy as utilization increases
More and more U.S. clinicians are using intravascular lithotripsy (IVL) for calcium modification during peripheral artery disease (PAD) treatments, according to new findings published in JSCAI.[1] In addition, researchers noted, IVL is associated with some specific advantages for PAD patients when compared to atherectomy.
Researchers reviewed U.S. Centers for Medicare and Medicaid Services (CMS) data from more than 420,000 endovascular revascularization procedures involving the femoropopliteal or tibial artery. All procedures were performed from 2019 to 2024. CMS first started covering peripheral IVL in the third quarter of 2020.
IVL utilization trends
Overall, the use of peripheral IVL has gradually increased since that CMS approval. It was being used for 10.2% of cases by the end of 2024. The use of atherectomy, meanwhile, has decreased from 38.5% to 31.6% since peripheral IVL became available. These trends were seen for both femoropopliteal and tibial artery procedures.
The study’s authors also noted that atherectomy is still used by a much wider variety of hospitals than peripheral IVL. Again, this was true for both femoropopliteal and tibial artery procedures.
More than 47,000 patients with a mean age of 76.9 years old either underwent IVL (12.9%) or atherectomy (87.1%) over the course of this analysis. Patients treated with IVL were more likely to be men or present with a higher burden of comorbidities. They were also more likely to undergo an inpatient procedure. At the same time, IVL patients were less likely to undergo treatment to both the femoropopliteal and tibial arteries.
Patient outcomes
After propensity score matching, IVL was associated with a lower risk of lower-extremity arterial thrombosis/embolism than atherectomy (1.3% vs. 3.2%). Rates of lower-extremity arterial dissection or perforation for the two treatment options were similar.
In addition, stenting during the index procedure was less common during IVL than it was during atherectomy (19.2% vs. 21.1%).
When it came down to a composite outcome of major amputation, surgical revascularization or death, IVL was associated with a slightly lower rate than atherectomy (38.6 vs. 39.7 per 100 person-years). A composite that only included major amputation and death was also less common after IVL than atherectomy (36.2 vs. 37.6 per 100 person-years).
Pneumonia and urinary tract infection occurred at similar rates after the two procedure types.
Researchers believe their data support the ongoing rise of peripheral IVL
Reviewing these findings, the team behind this analysis said their findings “support the growing role of IVL as a lesion-preparation strategy for calcified vascular disease.”
“Data directly comparing IVL with other calcium-modifying therapies—particularly atherectomy—remain scarce, resulting in limited evidence to inform device selection for lesion preparation in calcified PAD,” wrote first author Hyeok-Hee Lee, MD, PhD, a researcher with Beth Israel Deaconess Medical Center (BIDMC), and colleagues. “The present study addresses this gap by demonstrating that IVL is associated with a lower risk of thrombosis or distal embolization and a reduced need for stenting compared with atherectomy in contemporary real-world practice. Such procedural advantages likely stem from underlying mechanistic differences between the two devices and technical considerations related to their use. In turn, these advantages may have contributed to the higher procedural success rate and, ultimately, improved long-term outcomes observed in the present study.”
Click here to read the full study in JSCAI, a Society for Cardiovascular Angiography and Interventions journal.
Shockwave Medical did support this analysis through funding it provided to BIDMC. However, the company played no role in the design, interpretation or preparation of the team’s research.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.