Intravascular Lithotripsy In Calcified Vessels For High-Risk Bleeding Patients

Philippe Généreux, MD – Morristown Medical Center


TAVR pre-procedural planning allows physicians to identify which patients are at greater risk for bleeding complications.


  • 85-year-old female, frail (BMI 19), severe AS, small vessels, circumferential calcium, high bifurcation
  • Transfemoral Transcatheter Aortic Valve Replacement
  • Medtronic EVOLUTTM PRO 26mm (16F) in right femoral artery
  • Shockwave IVL (7F) in right external iliac and right common iliac artery with Saranas Early Bird Bleed Monitoring System (6F) in ipsilateral vein for intra and post-procedure surveillance


  • Multiple Shockwave lithotripsy treatments under Early Bird surveillance allowed valve deployment catheter to be inserted without vessel damage.
  • The Early Bird Bleed Monitoring System remained activated for post-procedure monitoring.
  • Patient was transferred to recovery area C- PACU with no indication of bleeding per Early Bird. The Early Bird was removed four hours post-procedure and patient was sent to the floor given great evaluation.

Discussion Points

Bleed monitoring during IVL with Shockwave is possible with the Early Bird.

The Early Bird Bleed Monitoring System provides assurance to clinicians that no intra and post-procedural bleeding events occur for a patient vulnerable to bleeding complications.