Imaging-Based Assessment of Plaque Modification Following Intravascular Lithotripsy in Femoropopliteal Disease: A Prospective Single-Centre Observational Study.

Authors

Katerina Sidiropoulou, Athanasios Saratzis, Christos Karkos, Konstantinos Tigkiropoulos, Nikolaos Saratzis, Dimitrios Karamanos

Published in

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. Oct 31, 2026. Epub Oct 31, 2026.

Abstract

Intravascular lithotripsy (IVL) is designed to treat calcified peripheral arteries with steno-occlusive disease; however, its effect on plaque morphology remains incompletely understood in vivo. This study evaluated plaque modification and luminal changes following IVL in femoropopliteal disease using computed tomography angiography (CTA) and intravascular ultrasound (IVUS).
This was a prospective single centre observational study. Consecutive patients with symptomatic femoropopliteal disease undergoing IVL between December 2024 and October 2025 underwent pre- and post-procedural (within five days) CTA with quantitative plaque analysis. IVUS was performed before and immediately after IVL, prior to drug coated balloon angioplasty (applied in all patients) or stenting (used only as bailout). The primary endpoint was change in calcified plaque volume on CTA. Secondary endpoints included luminal gain, haemodynamic changes, procedural success, and 6 month clinical outcomes.
Thirty nine patients were included; median age was 71 years. Calcified plaque volume showed a modest reduction (median proportional reduction 12.2%, p < .001) on post-procedural CTA. IVL resulted in luminal expansion, with IVUS measured lumen area increasing from 5.78 to 16.11 mm² (p < .001) immediately after IVL alone and CTA intraluminal volume increasing 52.7% (median). Haemodynamic improvement was observed (ankle brachial index: 0.80 to 1.00 (median); toe brachial index: 0.40 to 0.62 (median); p <.001) between baseline and 30 days. Intra-procedural dissections were detected in 18% of cases on IVUS; only two lesions (5%) were flow limiting and required stenting. At 30 days, no mortality or target lesion revascularisations were observed, while restenosis at 6 months occurred in 5% of cases. Chronic total occlusion was associated with residual stenosis in multivariable analysis (OR 6.2, 95% CI 1.11 - 34.48, p = .038).
IVL was associated with modest apparent plaque modification and significant luminal gain in calcified femoropopliteal lesions. Combined CTA and IVUS imaging suggest luminal expansion is primarily driven by plaque fracture, altered vessel compliance, and remodelling rather than debulking.

PMID:
42966558
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.

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