Intravascular lithotripsy (IVL), a catheter-based technique that fractures calcified plaque with pulsed pressure waves, is still being integrated into clinical practice alongside atherectomy and specialty balloons. In many labs, it is used as an added option rather than a direct replacement. The next phase will be shaped by how hospitals define when IVL is used routinely and how consistently teams can deliver treatment. IVL is progressing quickly, but repeatability across hospitals remains a constraint, according to GlobalData, a leading intelligence and productivity platform.
A CathPCI Registry analysis of 2.7 million percutaneous coronary interventions (PCIs) across US hospitals from 2018 to 2022 shows how quickly coronary IVL was adopted after its 2021 approval, rising from 0% to 7.8% of PCIs by late 2022. Over the same period, overall calcium modification use rose from 11.1% to 16%, while atherectomy declined from 5.4% to 4.4%, suggesting that IVL contributed to the net increase in procedures.
Ashley Clarke, Senior Medical Analyst at GlobalData, comments: “IVL appears to be expanding the pool of patients who gets treated, not just shifting share between devices. It can be straightforward to incorporate into existing workflows and is widely viewed as having a favorable safety profile. That may make operators more willing to treat lesions they might previously have deferred.”
On product development, vendors are targeting practical constraints seen in real-world cases. Early Shockwave coronary catheters delivered a fixed pulse count and could require a second catheter in more complex lesions, adding cost. Shockwave’s newer C2 Aero models have increased capacity, while Stryker and FastWave are pursuing higher pulse counts in their debut systems.
Other competitors are differentiating through platform design that could reduce capital needs, including Boston Scientific’s laser-plasma platform that shares one console across coronary and peripheral indications, and Elixir Medical’s fully mechanical concept, which avoids an external generator.
Clarke adds: “Interventional cardiology has long used multiple approaches to treat calcified lesions. Different atherectomy tools have coexisted because they fit different lesion patterns and because hospitals value continuity and familiarity. IVL may follow a similar path, where the mechanism matters, but purchasing and use are shaped by workflow fit, the ability to standardize outcomes across operators, and how well the IVL offering sits alongside a vendor’s existing cath lab portfolio.”
Peripheral IVL may become the next test of whether vendors can translate early adoption into standardized practice, but outcomes datasets are still developing. FastWave’s Artero system has entered its US pivotal trial, and multiple vendors are moving toward commercialization in below-the-knee disease, including Boston Scientific’s targeted Seismiq launch in 2026 and Stryker’s anticipated Pulse launch around 2027.
Clarke concludes: “IVL adoption still varies widely, so companies that pair credible evidence with training and implementation support, especially in PAD where workflows can be more variable, are more likely to secure durable adoption.”
