Shockwave L6 catheter expands treatment options for large-vessel cases

The benefits of Shockwave Medical’s new Shockwave L6 Peripheral Intravascular Lithotripsy (IVL) catheter—designed for use in large, calcified vessels (available in 8-12 mm diameter sizes), —were highlighted recently during a case-based roundtable discussion at the Society for Vascular Surgery’s 2023 Vascular Annual Meeting (VAM) in National Harbor, Maryland (June 14–17).

Karan Garg, MD (New York City) was joined by Misty Humphries, MD (Sacramento, California) and Mathew Wooster, MD (Charleston, South Carolina) to explore how the new device has changed their practice and treatment approach in larger vessels.

To illustrate use of the device in clinical practice, Humphries shared a case where Shockwave L6 was used to treat a calcified iliac artery to enable delivering of a large bore device. A 73-year-old man presented with a 7cm type 4 thoracoabdominal aneurysm and Humphries noted that physician-modified grafts are often used to treat these patients and that a percutaneous method is preferable, though she stressed that this requires a large device.

One alternative in cases such as this would be using a conduit, although Humphries highlighted that this is far from ideal, citing additional case time and increased blood loss. Essentially, she said, using a conduit makes a case “really challenging”.

For cases such as the one highlighted by Humphries, Garg remarked that the L6 is a “clear improvement” on the Shockwave M5+, an earlier, smaller-diameter device from Shockwave Medical—noting that it can be more effective at treating vessels with larger diameters.

Humphries reported a “great result” from the case using the L6, with the left common iliac (used for access) opened with no remaining stenosis.

Based on her clinical experience, Humphries advised users to oversize the device by 10% for optimal results. “This is not something to be afraid of,” she said, stressing that good wall apposition is key to breaking up calcium.

On a more general note, Garg admitted that while he was a “very slow adopter” of the L6 technology, he now holds the opinion that “once you start using it, you can’t get enough of it,” referencing his use of the technology in tibial vessels. “I find it very effective in that space”.

Similarly, Wooster noted that the L6 has expanded practitioners’ ability to get percutaneous access to the common femoral artery in patients who otherwise would have required a surgical cut-down. In addition, he shared that there are “really strong data” available showing benefit in these patients.

The Shockwave L6 catheter is available in the US-only.

This video is sponsored by Shockwave Medical.