Lithotripsy and Laser

Intravascular Lithotripsy (IVL) delivers acoustic shockwaves via a low-pressure balloon to fracture deep, intramural calcium without atherectomy-associated thermal injury or distal embolization risks. Excimer Laser Coronary Atherectomy (ELCA) utilizes pulsed ultraviolet energy (308 nm) to achieve photochemical (breaking molecular bonds), photothermal (vaporizing tissue), and photomechanical (creating acoustic shockwaves) ablation, proving exceptionally useful for uncrossable lesions and in-stent restenosis. ELCA protocols utilize a saline flush to mitigate acoustic trauma caused by blood or contrast in the field, since hemoglobin and iodinated contrast strongly absorb the 308 nm excimer wavelength and can generate excessive acoustic shockwaves and vapor-bubble formation that increase the risk of vessel injury.