Evidence on the safety and efficacy of intravascular lithotripsy for calcified coronary arteries during percutaneous coronary intervention (PCI) is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wishing to do intravascular lithotripsy for calcified coronary arteries during PCI should:
Inform the clinical governance leads in their NHS trusts.
Give patients clear information to support shared decision making, including NICE's information for the public.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these.
Enter details about all patients having intravascular lithotripsy for calcified coronary arteries during PCI onto the National Institute for Cardiovascular Outcomes Research (NICOR) database, and review local clinical outcomes.
The procedure should only be done by an experienced interventional cardiologist with specific training in the procedure.
Research could be a randomised controlled trial, comparing the procedure with current standard therapies, or an observational cohort study, including using registry data. Studies should include details of patient selection, the size and shape of the lesion, procedural success, minimal stent area and longer-term outcomes including survival.