Presenter: Stefano Fazzini, MD, PhD

Hospital: Vascular Surgery Unit, Tor Vergata University of Rome, Italy

Abstract

The IVLIAC multicenter study (74 iliac axes) demonstrates how intravascular lithotripsy (IVL) reshapes treatment strategies for calcified iliac lesions, significantly reducing stent implantation needs.

Introduction

Severe calcification in iliac arteries presents a dilemma: stenting risks underexpansion/rupture, while balloon angioplasty alone fails to modify calcium. The IVLIAC trial by Prof. Fazzini first confirms IVL enables stent-free revascularization safely.

Core Study: IVLIAC Multicenter Trial

1.Design:

3 Italian centers (Rome/Trento/Verona)

55 patients with 74 iliac arteries

Lesion characteristics: 87% proximal CIA or EIA 

Calcium arc: 180°-360°

2.Practice-Changing Findings:

3.IVL-Only Efficacy Evidence:

Hemodynamic Improvement:

Pressure gradient 50mmHg → 0mmHg 

EIA PSV decreased from 700cm/sec to 160cm/sec

Long-term Patency:

Three-phase CFA waveform maintained at 3 years (EVUS)

IVL Technology Highlights

1.Mechanism of Action:

50atm sonic waves selectively fracture calcium (density differential >80x) sparing elastic tissue

2.Clinical Advantages:

Superior Vessel Preparation: 300% lumen gain (OCT-proven)

Enhanced Safety: 3.3% complication rate in real-world study (Shock-India, n=1053)

Economic Value: Dedicated CMS DRG codes (MS-DRG 323-325)

Conclusions

1.New Stenting Standards:

"No-Stent Zones" (IIA territory/distal CIA/proximal EIA) prefer IVL-only

Stents reserved for bailout (residual stenosis >40% or flow-limiting dissection)

2.Assessment Revolution:

Replace angiography with EVUS + pressure gradient 

3.Future Directions:

IVL+DCB for TASC C/D lesions (IVLIAC II in preparation)