Intravascular lithotripsy (IVL) has become an important technology for treating heavily calcified coronary and peripheral arteries. Instead of relying only on high-pressure balloon inflation or atherectomy, IVL uses acoustic pressure waves to fracture calcium inside the vessel, helping physicians prepare the artery for balloon expansion and stent placement.
The competitive landscape is changing quickly. Shockwave Medical, now part of Johnson & Johnson MedTech, remains the leading commercial IVL company, while Boston Scientific, Abbott, Philips, and several emerging companies are developing or commercializing competing technologies.
1. Shockwave Medical – Johnson & Johnson MedTech
Shockwave Medical is the pioneer and current leader in IVL. Johnson & Johnson completed its acquisition of Shockwave for approximately $13.1 billion in 2024. At the time of the acquisition, Shockwave had treated approximately 400,000 patients across about 70 countries since its first product launch in 2017.
By 2025, Shockwave reported that more than 1 million patients had been treated with its technology. Its portfolio covers both coronary and peripheral disease, and the company launched the Javelin Peripheral IVL Catheter in the U.S. in March 2025.
Key data
| Shockwave Medical | Data |
|---|---|
| Acquisition value | $13.1B |
| Patients treated by 2025 | 1M+ |
| Countries reached at acquisition | 70 |
| First product launch | 2017 |
| Key areas | Coronary + peripheral IVL |
Pros
- Strongest clinical experience and physician familiarity.
- Commercial IVL portfolio for both coronary and peripheral applications.
- Backing from Johnson & Johnson provides substantial global resources.
- Large clinical evidence base.
Cons
- High level of competition is emerging.
- IVL devices can add significant procedural costs.
- Availability and reimbursement can vary by market.
2. Boston Scientific
Boston Scientific has emerged as one of the strongest potential challengers. In January 2025, the company agreed to acquire Bolt Medical for up to approximately $664 million, gaining its laser-based IVL technology.
The company’s SEISMIQ IVL System uses acoustic pressure waves delivered through a balloon catheter. Boston Scientific’s 2025 annual report described IVL as one of the fastest-growing medical-device segments and said the system was in limited market release, with the FRACTURE IDE trial underway for coronary applications.
Key data
| Boston Scientific | Data |
|---|---|
| Bolt acquisition value | Up to $664M |
| 2025 net sales | $20.1B |
| 2025 patients treated with WATCHMAN | 600,000 |
| IVL technology | SEISMIQ |
Pros
- Large cardiovascular device portfolio.
- Strong hospital and physician relationships.
- Significant R&D and commercialization resources.
- IVL technology complements its existing interventional portfolio.
Cons
- Its IVL franchise is newer than Shockwave’s.
- Coronary IVL development is still progressing through clinical studies.
- Limited-market rollout means adoption is still developing.
3. Abbott
Abbott is another major cardiovascular company entering the IVL competition. The company acquired Cardiovascular Systems Inc. (CSI) for approximately $890 million in 2023, adding calcium-modification expertise to its cardiovascular portfolio.
Abbott received approval to begin its TECTONIC CAD IVL IDE study, which is designed to evaluate its coronary IVL system in 335 patients at up to 55 U.S. sites.
Key data
| Abbott | Data |
|---|---|
| CSI acquisition | $890M |
| TECTONIC CAD study | 335 patients |
| Planned U.S. sites | Up to 55 |
| Key focus | Coronary IVL |
Pros
- Strong global cardiovascular business.
- Existing expertise in coronary intervention.
- Large physician and hospital network.
- CSI acquisition adds calcium-modification capabilities.
Cons
- Coronary IVL platform remains in clinical development.
- Does not yet have the same commercial IVL history as Shockwave.
- Must establish physician confidence in a new platform.
4. Philips
Philips is approaching IVL from a slightly different angle by combining laser atherectomy and laser-based IVL.
In 2024, Philips enrolled the first U.S. patient in its THOR IDE clinical trial, evaluating a single device designed to perform both laser atherectomy and laser-based intravascular lithotripsy for peripheral artery disease.
Key data
| Philips | Data |
|---|---|
| U.S. THOR trial | Initiated 2024 |
| First U.S. patient | 2024 |
| Technology | Laser atherectomy + IVL |
| Primary focus | Peripheral artery disease |
Pros
- Combines two calcium-modification approaches in one device.
- Strong image-guided therapy and cardiovascular background.
- Potential to simplify treatment of complex peripheral lesions.
Cons
- Technology is still being evaluated clinically.
- More complex technology may require additional physician training.
- Commercial availability is more limited than established Shockwave systems.
5. FastWave Medical and Other Emerging Players
Competition is also coming from smaller technology companies. FastWave Medical, for example, is developing different IVL platforms for peripheral and coronary applications. Other companies and technologies being watched include Amplitude Vascular Systems/Stryker, Elixir Medical, MicroPort, and Cagent Vascular.
The competitive environment is therefore moving beyond a single dominant supplier toward multiple technologies using different energy sources, catheter designs, and treatment approaches.
Pros
- Encourages innovation and potentially more treatment options.
- New systems may address limitations of first-generation IVL.
- Increased competition could improve hospital purchasing leverage.
Cons
- Many platforms are still in clinical development.
- Long-term clinical evidence is less extensive.
- Regulatory approval and commercialization remain important hurdles.
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