Exploring the Efficacy and Safety of Shockwave Intravascular lithotripsy in Patients of Acute Coronary Syndrome

The increasing global burden of coronary artery disease is complicated by advanced multivessel disease and severe coronary artery calcification. Extensive coronary calcification reduces arterial compliance and predisposes to stent under expansion, malapposition, restenosis, and procedural complications during percutaneous coronary intervention. While traditional debulking techniques like atherectomy exist, they rely on mechanical abrasion or high-pressure barotrauma. Intravascular lithotripsy (IVL) has emerged as a novel, energy-mediated alternative that uses localized acoustic pressure waves to fracture superficial and deep coronary calcium, increase vessel compliance, and facilitate safe stent expansion. This narrative review synthesizes clinical trial data, multicenter registries, intravascular imaging substudies, and device development reports to define the contemporary role, procedural outcomes, safety profile, and limitations of coronary IVL. Across pivotal trials and real-world registries, including the sisrupt coronary artery disease studies, IVL-facilitated percutaneous coronary intervention yields high device success (92.4–98%) and low device-related complication rates (about 1%), with short-term major adverse cardiovascular event rates typically in the single digits and 1-year event rates varying between 9% and 13% in high-risk cohorts. IVL represents a safe and effective strategy for modifying coronary calcification and facilitating optimal stent deployment in complex percutaneous coronary intervention. While current data are robust, further randomized head-to-head trials against atherectomy and long-term surveillance beyond 2 years are required to define its definitive role in complex scenarios, such as acute coronary syndromes.