Shockwave Lithoplasty versus 355-nm Laser for Vessel Preparation in Calcified Femoropopliteal Arterial Disease: A Single-Center Comparative Study

Abstract Comparative data on vessel preparation using intravascular Shockwave lithotripsy (Johnson and Johnson, New Brunswick, NJ) or the 355-nm Auryon laser (Angiodynamics, Latham, NY) in calcified femoropopliteal arterial disease is limited. This is a retrospective, single-center study evaluating the 30-day safety and effectiveness of the 355-nm laser system versus Shockwave lithotripsy in treating calcified femoropopliteal arterial disease. Angiographic images were reviewed by core laboratory. The primary endpoint of safety is freedom from major adverse limb event (MALE) at 1 month. The primary effectiveness endpoint is acute procedural success, defined as achieving less or equal 30% mean residual narrowing postfinal treatment with no bailout stenting. A total of 29 consecutive patients were included (355-nm laser 15 patients [15 vessels] and Shockwave lithoplasty 14 patients [15 vessels]). At baseline, there were no differences between the two cohorts in demographics or clinical presentation. Also, there were no difference in total occlusions (33.3 vs. 33.3%), lesion length (median: 12.0 vs. 12.1 cm), presence of moderate to severe calcium (86.7 vs. 100%). At 30-day, there were no MALEs in both groups. There were no perforations, type D dissections, or distal embolization seen in both cohorts. Bailout stent was driven by a higher residual stenosis and was 35.7 vs. 13.3% in Shockwave versus laser, respectively (p = 0.215). At 30-day ankle–brachial indices were similar between the two groups (median: 0.9 vs. 1.09). Both Shockwave and 355-nm laser are effective and safe in calcified femoropopliteal lesions. A numerically higher rate of bailout stenting was seen with Shockwave lithoplasty.