Pressure-Wave Therapy Shows Safety in Calcified Arteries

Adults with severely calcified coronary arteries saw a 0.3% target lesion failure rate at 30 days in a 335-patient trial.

Updated on Nov. 2, 2026 in Heart Disease

Close view of a coiled balloon catheter tip resting on a pale blue sterile drape, with a blurred instrument tray behind it. — Two studies at TCT 2026 found pressure-wave therapy, known as intravascular lithotripsy, safe in severely calcified coronary arteries, with a 0.3% target lesion failure rate at 30 days in 335 patients. AI Illustration. Upload story photo >

Two studies presented at TCT 2026 evaluated intravascular lithotripsy (IVL), a pressure-wave technique used to break up hard calcium blocking coronary arteries. The TECTONIC CAD trial found IVL safe and effective in severely calcified coronary lesions, and a companion study examined how best to treat calcified nodules in the same setting.

Why it matters

Heavily calcified arteries are one of the harder problems in treating coronary artery disease, because stiff plaque can make it difficult to fully open a vessel and place a stent. Findings that support IVL in this group give cardiologists and their patients more evidence for a tool that can improve stent placement in U.S. cardiac centers.

TECTONIC CAD is a multicenter trial of 335 patients at 40 U.S. centers using the SonicForce Coronary IVL System, with a 30-day median follow-up, a 0.3% target lesion failure rate, and 97% procedural success. The NODULE-SHOCK trial randomized 120 patients with severe calcification, and the stub does not report follow-up beyond the procedural outcomes.

The players

SonicForce Coronary IVL System

A coronary intravascular lithotripsy system used in the TECTONIC CAD trial to treat severely calcified lesions.

The details

IVL delivers sonic pressure waves through a balloon catheter that cracks calcium within the artery wall, making the vessel more pliable so a stent can expand fully. In the NODULE-SHOCK study, patients with calcified nodules received either OCT-guided rotational atherectomy plus IVL or IVL alone, and adding atherectomy increased final stent area at the nodule site. In patients with severe calcification but no nodules, higher-intensity IVL pulses did not significantly increase stent area compared with operator-determined pulses.

TECTONIC CAD's safety and effectiveness were assessed over a 30-day follow-up period.
Both studies were presented at TCT 2026 and published in JACC: Cardiovascular Interventions on November 1, 2026.

Health Landscape

Calcified coronary disease has long been harder to treat with standard balloon angioplasty and stenting, which often struggle to fully open stiff plaque. IVL is an emerging approach that softens calcium before stent placement, and these trials add evidence on how it performs across different calcification patterns.

If you have been told you have heavy calcium in your coronary arteries, it is reasonable to ask your cardiologist whether IVL is an option for stent placement. These results support IVL as a safe option in this group, but the decision belongs in a conversation with your physician.

The takeaway

Intravascular lithotripsy appears safe and effective for severely calcified coronary lesions in early trial data. If you have calcified arteries, ask your cardiologist whether this approach fits your situation.