Intravascular Lithotripsy Shows Safety in Calcified Lesions
Two TCT 2026 studies evaluated intravascular lithotripsy for severely calcified coronary lesions in patients with coronary artery disease.
Updated on Nov. 2, 2026 in Heart Disease
Two studies presented at TCT 2026 and published in JACC: Cardiovascular Interventions assessed intravascular lithotripsy in severely calcified coronary lesions. The TECTONIC CAD trial found the procedure safe and effective in severely calcified de novo coronary lesions.
Why it matters
Severely calcified coronary lesions are difficult to treat with stents, and the findings offer evidence on a technique used to prepare such lesions before stent placement. Results from the NODULE-SHOCK trial add guidance on when additional calcium modification may be needed.
The TECTONIC CAD trial, which enrolled 335 patients at 40 U.S. centers, reported a 0.3% target lesion failure rate at 30 days and 97% procedural success, with the SonicForce Coronary IVL System used. Longer-term durability beyond the 30-day median follow-up has not yet been established.
The players
TECTONIC CAD trial
A U.S. multicenter study that evaluated the SonicForce Coronary IVL System in severely calcified de novo coronary lesions.
NODULE-SHOCK trial
A study that compared rotational atherectomy plus intravascular lithotripsy with lithotripsy alone in patients with calcified nodules.
The details
Researchers evaluated intravascular lithotripsy, a technique that uses sonic pressure waves to break up calcium in coronary arteries. The NODULE-SHOCK trial divided 120 patients with severe calcification into cohorts with and without calcified nodules, and a prespecified OCT substudy examined calcium modification and stent expansion.
Timeline
30 days: median follow-up period for TECTONIC CAD safety and effectiveness endpoints.
November 1, 2026: Both studies were presented at TCT 2026 and published in JACC: Cardiovascular Interventions.
Heart Disease Landscape
Calcified coronary lesions have long complicated stent placement, and these TCT 2026 studies add multicenter evidence to the use of intravascular lithotripsy as a preparation method. The results sit within a field still awaiting larger trials with clinical endpoints to confirm durability.
For patients with severely calcified coronary artery disease, these findings suggest intravascular lithotripsy may be an option to prepare lesions for stenting, though decisions depend on individual anatomy and clinician judgment. Patients should discuss with their cardiologist whether calcium modification techniques are appropriate for their condition.
The takeaway
Patients and clinicians facing heavily calcified coronary blockages should note that intravascular lithotripsy showed low short-term complication rates, but longer-term evidence from larger trials is still needed.
Further reading
Explore more on Heart Disease and related cardiac treatment research.
Source note: This article includes information reported by American College of Cardiology.
