NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
 
Status In progress
Process IP
ID number 1758
Description In this procedure, shockwave intravascular lithotripsy is administered to the calcified coronary artery before stent deployment during PCI. A percutaneous guidewire is passed from the radial or femoral artery into a coronary artery. Then, an intravascular lithotripsy catheter with embedded emitters enclosed in an integrated angioplasty balloon is passed and connected to an external generator with a connector cable. The catheter is advanced to the target lesion guided by radiopaque markers on the catheter. The balloon is then inflated with a saline and contrast solution to ensure contact with vessel wall. The lithotripsy cycle is then activated. For every cycle, the catheter emits localised, high-energy, pulsatile, unfocused, circumferential, acoustic, sonic, pressure waves (lasting microseconds). These waves pass through the inflated balloon into the wall of the coronary artery. As the waves travel along the wall and the connective tissue, they disrupt calcium deposits (both intimal and medial calcium) by microfracturing the calcified lesions. The cycle can be repeated until the lesion has been expanded sufficiently to allow optimal stent placement and optimisation. Intravascular lithotripsy during PCI may allow stent delivery and expansion, modify focal intravascular calcium whilst limiting localised injury to the endovascular surface.

Provisional Schedule

Interventional procedure consultation 21 November 2019 - 19 December 2019
Expected publication 18 March 2020

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance