SnackableHealth™ | VICTORY: Intravascular Lithotripsy Proves Safer and More Effective Than Super-High-Pressure PTCA in Complex Calcified Lesions

In this SnackableHealth™ episode from TCT 2025, Dr. Matthias Bossard and Dr. C. Michael Gibson discussed the results of the VICTORY trial, a head-to-head comparison of intravascular lithotripsy (IVL) and super-high-pressure percutaneous transluminal coronary angioplasty (PTCA) in patients with severely calcified or refractory coronary lesions.

Dr. Bossard explained that calcified lesions remain one of the most significant barriers to successful PCI, often leading to stent underexpansion, dissection, or restenosis. The VICTORY study was designed to determine whether IVL—a technology using acoustic pressure waves to fracture calcium within the arterial wall—could provide safer and more consistent lesion preparation than aggressive balloon inflation.

The findings were clear: IVL achieved higher procedural success and greater luminal gain compared with super-high-pressure PTCA, with significantly fewer dissections and perforations. “What’s striking is that lithotripsy allows controlled calcium modification without vessel trauma, something traditional high-pressure techniques struggle to deliver,” noted Dr. Bossard.

Dr. Gibson emphasized the broader implications for clinical practice: “Intravascular lithotripsy has evolved from a niche therapy into a frontline strategy for managing heavily calcified lesions. These results reinforce that safety and efficacy can go hand-in-hand, even in the most complex cases.”

Both experts agreed that IVL’s predictable performance and safety profile make it an increasingly attractive option, especially for elderly patients or those with diffuse calcification, where traditional approaches carry elevated risk.