Novel Intravascular Lithotripsy Balloon for Complex Coronary Calcification: Two Cases Demonstrating Feasibility and Safety

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J INVASIVE CARDIOL 2026. doi:10.25270/jic/26.00218. Epub July 16, 2026.

Case 1

A 67-year-old woman presented with a non-ST-segment elevation myocardial infarction. Coronary angiography showed a critical ostial left circumflex (LCx) lesion, LCx in-stent restenosis (ISR), a severe intermediate branch lesion, and complex left main coronary artery (LMCA) trifurcation disease (Figure 1A, Video 1). Intravascular ultrasound demonstrated severe LCx stent underexpansion and a calcified nodule involving the distal LMCA-ostial LCx segment (Figure 1B and C, respectively; Video 2).

Predilation with noncompliant (NC) balloons and paclitaxel-coated balloon angioplasty failed to achieve adequate expansion. Intravascular lithotripsy (IVL) to the mid-LCx ISR and to the distal LMCA-ostial LCx segment was performed using a 3.0 x 15-mm ShockFast balloon (Shunmei Medical) (Figure 1D and E). The intermediate branch was treated with 2 drug-eluting stents (DES). Final triple kissing-balloon inflation was performed, followed by proximal optimization technique of the LMCA, achieving an optimal angiographic result (Figure 1F and G).

Case 2

A 62-year-old man underwent percutaneous revascularization of a severely calcified mid-left anterior descending (LAD) lesion (Figure 2A and B). Optical coherence tomography (OCT) showed severe calcification with a minimal lumen area of 2.5 mm² (Figure 2C). IVL was performed using a 2.5 x 15-mm ShockFast balloon. Repeat OCT demonstrated multiple calcium fractures (Figure 2D, Video 3) and a single DES was implanted. Mild post-stent underexpansion (70%) was corrected with NC balloon postdilation (Figure 2E). Final OCT confirmed an excellent result (minimal stent area: 4.8 mm²) (Figure 2F and G, Video 4).

We report the first successful use of the novel ShockFast IVL system in Spain,¹ and one of the first in Europe. By delivering IVL pulses more rapidly, ShockFast reduces balloon inflation and ischemic time, which may be advantageous when treating proximal vessels, such as the LMCA. Our experience supports the efficacy and safety of this novel IVL technology. Together with a broader range of balloon sizes, ShockFast may expand the versatility of IVL in complex calcified coronary lesions.²

Carmen Labarta-Bello, MD^1,2; Mattia Basile, MD^1,2; Gonzalo Acedo, MD^1,2; Miguel A. Martín-Arena, MD^1,2; Adrián Martínez-Roca, MD^1,2; Javier Gómez-Herrero, MD^1,2; Borja Rivero-Santana, MD, PhD^1,2; Daniel Tébar-Márquez, MD^1,2; Santiago Jiménez-Valero, MD^1,2; Guillermo Galeote, MD, PhD^1,2; Benjamin Faurie, MD³; Elvin Kedhi, MD, PhD⁴; Raúl Moreno, MD, PhD^1,2,5; Alfonso Jurado-Román, MD, PhD^1,2,5

From the ¹Cardiology Department, La Paz University Hospital, Madrid, Spain; ²Fundación de Investigación IDIPAZ, Madrid, Spain; ³Infirmerie Protestante de Lyon, Caluire-et-Cuire, France; ⁴Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada; Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland; ⁵Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain.

Dr Jurado-Román and Dr Moreno share last authorship.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement: The authors confirm that informed consent was obtained from the patients for the procedures described in the manuscript and for publication thereof, including any and all images.

Address for correspondence: Carmen Labarta-Bello, MD, Cardiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain. Email: carmenlabarta98@gmail.com; X: @carmen_labarta