For decades, doctors have struggled with the same stubborn problem: arteries hardened by calcium are too rigid for standard tools to open safely. A relatively new technology is changing that — and the largest names in medical devices have spent billions of dollars on the category.
Intravascular lithotripsy, or IVL, has quickly become one of the most closely watched categories in cardiovascular medicine. The technology uses acoustic pressure waves to fracture hardened calcium inside arteries, making it easier for physicians to restore blood flow and deliver therapies such as balloons or stents — a category that didn’t exist commercially a decade ago and is now reshaping how some of the most difficult vascular procedures are treated.
For years, calcium has been one of the most frustrating diseases to treat for cardiologists, vascular surgeons, and radiologists. Calcified vessels can be rigid, difficult to open, and harder to manage in a predictable way. Traditional approaches like high-pressure balloons and atherectomy can play important roles, but they come with limitations. IVL offers something different: a way to modify calcium within the artery using sonic energy.
In just over 18 months, three of the largest medtech corporations have moved to acquire IVL companies.
Johnson & Johnson’s $13.1 billion acquisition of Shockwave Medical in 2024 validated IVL at the highest level. Boston Scientific followed in early 2025 with an agreement to acquire Bolt Medical, a developer of a laser-based IVL platform for nearly a billion dollars. This was especially notable not just for its size but because Bolt had not yet reached commercial maturity. Then, in April 2026, Stryker signed a definitive agreement to acquire Amplitude Vascular Systems (AVS), adding IVL technology to its peripheral vascular portfolio.
Three deals, one clear message: the race to own the next generation of IVL technology is accelerating.
The category still has room to grow. Shockwave IVL is used in roughly 10-15% of U.S. percutaneous coronary interventions today, compared with an addressable market closer to 20-25%, according to Citeline’s Medtech Insight. Carotid and structural heart applications could add billions more to the potential size of the category.
That raises a natural question. As Shockwave, Bolt, and AVS move into the portfolios of the industry’s biggest players, which independent IVL startups are still building on their own terms?
FastWave Medical, a venture-backed IVL innovator developing next-generation platforms for both coronary and peripheral artery disease, stands out as one of the most notable remaining independent players.
IVL: A Category in Motion
The strategic interest in IVL reflects a problem of significant scale.
Coronary artery disease alone claims roughly 300,000 American lives each year and accounts for one in four U.S. deaths, with approximately 17.8 million deaths attributed globally.
Calcified arterial disease sits at the center of that problem, and as populations age and rates of diabetes and obesity rise, the patient population continues to grow.
What makes IVL attractive to multi-national medical device companies is that the technology is still evolving. First-generation platforms established the category, but the next wave — devices designed for better deliverability, faster treatment, and more complex anatomy — is where the field is heading.
The Deal Timeline: Shockwave, Bolt, AVS
A pattern runs through the more recent deals. Boston Scientific moved on Bolt’s laser-based IVL platform before it had reached full commercial maturity. Stryker’s agreement with AVS came at a similarly early stage.
Each transaction points to a willingness to invest in the next generation of IVL, not just what’s already on the market.
Stryker’s purchase of AVS, a pre-commercial startup, is the most recent move. “This acquisition is a significant milestone in expanding our peripheral vascular portfolio and enhancing our ability to address challenging arterial disease,” said Kevin Lobo, chair and CEO of Stryker.
Together, the series of deals points to a category that’s still taking shape.
Building Next-Generation IVL on Their Own Terms
- FastWave Medical’s Sola L-IVL — Image courtesy of FastWave Medical
FastWave is developing two advanced IVL platforms in parallel: Sola, a laser-based coronary system, and Artero, an electric platform for peripheral artery disease.
The dual-system approach gives the company exposure to both coronary and peripheral markets — a breadth that matters when large medical device companies are thinking across portfolios.
“Physicians who have done hundreds of IVL cases told us exactly where the friction was. So, we designed our two platforms around those specific problems,” FastWave co-founder and CEO Scott Nelson told Medtech Insight. That physician input shaped both systems from the start. For Nelson, it’s also why FastWave is building independently. “That kind of speed and creativity is harder to maintain inside a larger organization. We think the same playbook applies here.”
So far, FastWave has raised more than $50 million from physicians, venture firms, and industry leaders. It has also earned notable industry recognitions, including a place on Fierce Medtech’s list of the 15 most promising private medical device companies and MD+DI’s 2025 Medtech Company of the Year.
The company’s early clinical results have been impressive. Artero — FastWave’s peripheral platform — restored near-complete blood flow in every patient treated. Sola, which is designed to treat coronary artery disease, finished its first 30-patient trial, with doctors successfully placing stents in every case with no device-related complications.
FastWave’s trajectory is still being written, but the direction is clear. Two platforms are moving toward U.S. pivotal trials. The clinical signals are early but encouraging. Industry is taking notice. In a category that is still finding its shape, that’s a position worth watching.
Spencer Hulse is the Editorial Director at Grit Daily. He is responsible for overseeing other editors and writers, day-to-day operations, and covering breaking news.
