About a week ago, 88-year-old Dr MB Shah got admitted to Mumbai's Holy Spirit hospital for removal of major heart blockages. The calcified blockages had hardened in the arteries and to open them up, doctors at the hospital used the 'intravascular lithotripsy (IVL) or the Coronary Shockwave Lithotripsy, a therapy which treats such artery blockages with 'sonic pressure waves.' Sonic pressure waves have been used since years for the removal of kidney stones and is now being applied in the heart for breaking calcium blockages. Shockwave Intravascular Lithotripsy is a novel procedure that brings hope for those suffering from an advanced form of coronary artery disease (CAD) having angina or heart attack in which the blockage becomes very hard due to deposit of calcium. This happens in patients who are elderly, diabetic, have chronic kidney disease, long-standing blockages or previous bypass surgery.
The calcium gets developed slowly and progresses to its hardened form within the heart arteries of elderly people. It gets developed slowly but its impact is immediately encountered when performing procedures in calcified lesions. The calcium’s hardened structure restricts normal artery movement and makes the rigid arterial tissue resistant to traditional balloon therapies that have been designed to compress the plaque within the artery wall to restore normal blood flow. Presence of calcium increases the complexity of most cases and decreases the effectiveness of most treatments.
Dr Amit Sharma, Interventional Cardiologist at Holy Spirit Hospital said, “For many years, calcium around the coronaries has made it difficult for old, diabetic patients with complex coronary artery disease. The calcium in the arteries is so hard that the balloon that is usually used to make room for the stent, itself ruptures. Intravascular lithotripsy (IVL) is designed to generate sonic pressure waves to break up calcified artery blockages historically used to treat patients with kidney stones." This new technology makes the angioplasty much easier for elderly patients who have calcium deposition in the artery because through this it is easier to put stent inside for blood flow. “The Coronary Shockwave Lithotripsy involves advancing a specialised catheter and delivering pulsatile sonic pressure waves at the blockage site to break the calcium in the artery wall. At the same time, these sonic waves pass through surrounding soft vascular tissue in a safe manner, so that the blood flow in the artery is never affected. This procedure is done with imaging (Intravascular ultrasound/ OCT) to make sure the passage of stents subsequent to the pressure wave therapy is easy,” added interventional cardiologist Dr Pinto.
Currently, rotabulator procedure is used for removing calcium present inside the artery but this may sometimes result in an increased risk for adverse events since they don’t differentiate between the calcific lesion and soft intimal tissue of the artery. While these are still early days to comment on this mode of therapy, it is very clear that this is a game-changing technology for the treatment of calcified coronary artery disease.”