TCT-909 Comparative Effectiveness of Laser Versus Shockwave Intravascular Lithotripsy for Calcified Coronary and Peripheral Artery Lesions: A Systematic Review and Meta-Analysis

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Severe vascular calcification in coronary and peripheral arteries remains a major challenge for endovascular therapy. Intravascular lithotripsy (IVL), using either laser or shockwave energy, has emerged as a novel solution for plaque modification. Our objective was to compare the safety and efficacy of laser IVL versus shockwave IVL in the treatment of heavily calcified lesions in both coronary and peripheral arterial territories, including analysis of patient demographics, clinical outcomes, and modality-specific strengths and limitations. Methods: A systematic review and meta-analysis of 18 studies (5,302 patients) comparing laser IVL and shockwave IVL was performed. Outcomes assessed included procedural success, device success, acute lumen gain, target lesion revascularization (TLR), and major adverse events (MAEs). Subgroup analyses by arterial territory (coronary vs peripheral) and patient demographics were performed. Results: Of 5,302 patients (mean age 69 ± 9 years, 62% male, 42% diabetic, 36% with chronic kidney disease [CKD]), 2,418 underwent laser IVL and 2,884 underwent shockwave IVL. Shockwave IVL showed higher device success in coronary arteries (98.3% vs 92.1%, p< 0.001) and fewer procedural complications (p=0.02). In peripheral arteries, laser IVL had greater acute lumen gain (3.1 mm vs 2.6 mm, p=0.01) and lower bailout stenting rates (p=0.04). TLR rates at 12 months were lower in shockwave IVL in coronary lesions (8.6% vs 12.4%, p=0.03), but similar in peripheral lesions. Conclusion: Shockwave IVL demonstrates superior safety and device success in coronary interventions, while laser IVL shows benefits in plaque debulking and lumen gain in peripheral arteries. Device selection should be tailored to vascular bed, lesion morphology, and patient-specific factors. Categories: CORONARY: Coronary Atherectomy, Plaque Modification, Lithotripsy, Thrombectomy, Cutting/Scoring Balloons

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B390

Last Page

B391

Comments

Transcatheter Cardiovascular Therapeutics held 2025-10-25 to 2025-10-28 in San Francisco, CA

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