IVL market expands but hospital adoption still uneven

Atherectomy use fell to 4.4 % from 5.4% during the period

The intravascular lithotripsy (IVL) market is expanding as medical-device companies develop systems for calcified coronary and peripheral lesions, but uneven hospital adoption remains a constraint on growth, according to GlobalData.

Coronary IVL use in the US rose to 7.8% of percutaneous coronary interventions (PCIs) in late 2022 from 0% in 2021, based on an analysis of 2.7 million PCIs in the CathPCI Registry.

Overall calcium modification use increased to 16% from 11.1% over the same period, whilst atherectomy use fell to 4.4% from 5.4%.

“IVL appears to be expanding the pool of patients who gets treated, not just shifting share between devices,” said Ashley Clarke, Senior Medical Analyst at GlobalData. “It can be straightforward to incorporate into existing workflows and is widely viewed as having a favourable safety profile.”

IVL is being used alongside atherectomy and specialty balloons rather than as a direct replacement.

Clarke said hospitals are likely to determine the technology’s role based on workflow, consistency between operators, purchasing decisions, and how IVL systems fit within existing cath lab portfolios.

Competition is also increasing as companies develop systems with higher pulse counts, different energy platforms, and lower equipment requirements.

“Interventional cardiology has long used multiple approaches to treat calcified lesions,” Clarke said.

IVL may follow a similar path, with purchasing and use shaped by workflow fit, the ability to standardise outcomes across operators, and how well the technology fits within existing cath lab portfolios, she said.

The peripheral segment could provide the next growth opportunity for IVL companies, although outcomes data remain under development.

Clarke said companies will need to combine clinical evidence with training and implementation support to secure adoption, particularly in peripheral artery disease, where workflows can vary between hospitals.

“IVL adoption still varies widely, so companies that pair credible evidence with training and implementation support, especially in PAD where workflows can be more variable, are more likely to secure durable adoption,” she said.