Crack the rock: the role of coronary lithotripsy for heavy calcified lesions

Since the first balloon angioplasty 40 years ago, percutaneous coronary interventions (PCI) applicability continues to expand, even in the context of complex coronary anatomies, previously considered unsuitable for PCI. A very challenging scenario for PCI is the treatment of heavily calcified coronary stenosis that is associated with early complications and late adverse events. Countless tools and techniques have been introduced to treat calcified coronary stenosis, and among these, a new and promising technique obtained from lithotripsy technology employed for the treatment of uretero-renal calculi has been introduced: the intravascular lithotripsy (IVL). IVL utilizes acoustic shockwaves in a balloon-based delivery system that induces calcium fractures, facilitating stent advancement and expansion. This review aims to describe the device used for IVL, the results of clinical studies published, and the possible clinical use.