When 72-year-old Barbara M. showed up for her peripheral artery disease consultation, she was hopeful but worried. Years of diabetes and high blood pressure had narrowed the arteries in her legs to the point that walking even a block was painful. Her vascular team knew the problem: severe calcification, the kind that makes endovascular procedures more difficult and open surgery less predictable and often less durable.
For vascular specialists, calcification has long been a formidable challenge. In complex cases, the presence of heavy calcium can limit the effectiveness of traditional tools and compromise outcomes. Dr. Lee Kirksey, Vice Chair of the Department of Vascular Surgery at the Cleveland Clinic, described it in a recent interview with FastWave Medical as a core limitation in both open and endovascular work.
“There’s nothing we vascular specialists lament more than calcified blood vessels, whether open or endovascular,” Kirksey said. “I tell my trainees all the time that this is our Achilles’ heel. It makes open operations more difficult and sometimes less durable.”
A Persistent Obstacle in Cardiovascular Care
Throughout the evolution of endovascular therapies, calcium has remained one of the most stubborn barriers to success. Devices that promised ease often stumbled when confronted with severe calcification. Modalities like high-pressure balloons and atherectomy come with limitations and risks.
Intravascular lithotripsy (IVL) is now gaining traction as a frontline solution. By using pulsatile acoustic pressure waves to safely fracture calcium within the vessel wall, IVL enables more complete expansion and improved outcomes without the trauma associated with other treatment options.
As Dr. Venita Chandra, a vascular surgeon at Stanford Health Care in Palo Alto, CA, explains, “I compare IVL to dropping a stone in a pond, creating ripples of energy that break through hardened plaque. With IVL, we’re able to precisely target and create tiny cracks in even the hardest calcified plaque into tiny fragments retained within the arterial walls, making the vessels more flexible and treatable with balloons or stents without risking the kind of trauma or less-than-ideal results associated with other methods.”
Dr. Alexander G. Truesdell, an interventional cardiologist at Virginia Heart and the Inova Schar Heart and Vascular Institute, says, “When you consider the devices out there—laser, intravascular lithotripsy (IVL), rotational atherectomy, or orbital atherectomy—I think IVL has been a game-changer. However, its effectiveness hinges on proper device selection guided by intracoronary imaging.”
Beyond the Device: What Meaningful Innovation Looks Like
As IVL adoption grows, attention is turning toward what’s next: systems that offer even better deliverability, more versatility, and faster, more effective therapy for the most complex anatomies.
One innovator leading this next phase is FastWave Medical, developing advanced IVL platforms rooted in close collaboration with physicians. According to Dr. Peter Schneider, Professor of Surgery at the University of California, San Francisco, there’s real excitement around the progress being made.
“I’m particularly excited about what we’re seeing from FastWave Medical. Their electric-IVL system promises improved deliverability, more pulses per catheter, a faster pulse rate, and a more rupture-resistant balloon material with a nice rewrap, enabling the treatment of multiple lesions with the same device. Plus, the system’s emitter is designed to deliver more uniform circumferential cavitation and consistent sonic pressure. Beyond this, FastWave is also developing a laser-based IVL system with a coronary application,” he says.
True innovation, as Dr. Schneider and others note, doesn’t just mean upgrading the tool. It is also rethinking how challenges like calcium are approached across the cardiovascular spectrum.
IVL is a Game-Changer
Apologies for the reuse of the term, but if it fits, it fits. The energy around IVL reflects a fundamental shift in how physicians think about treating heavily calcified lesions and what outcomes they can expect.
Dr. Samin Sharma, Director of Interventional Cardiology at Mount Sinai Hospital, puts it plainly: “The introduction of intravascular lithotripsy (IVL) has been a game-changer.”
That sentiment is echoed across the field. IVL fills a gap and elevates the entire standard of care. For patients, it means smoother procedures and better long-term results. For physicians, it means safer, more predictable interventions. And for the broader vascular and coronary spaces, it signals a new frontier for overcoming what was once one of the most frustrating obstacles in the cath lab.
For people like Barbara, it means a chance to walk without pain, to avoid invasive surgery, and to regain a sense of normalcy that once felt out of reach. IVL is restoring mobility, independence, and quality of life for the millions living with advanced cardiovascular disease.
That, ultimately, is what progress in medicine is about.
