Occurrence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. A promising new addition to the armamentarium for treatment of severely calcified lesions in the coronary and peripheral vasculature is the adaptation of lithotripsy technology for vascular calcification.
Although there are several modalities available in treating calcified coronary arteries, Dr. Anil Mishra, consultant, Interventional cardiologist, BM Birla Heart research centre and his team performed a very novel procedure of ‘Shock Wave Therapy to open calcified blocked heart arteries. The arteries were not getting cleared by the usual procedure, so the doctor used the new and uncommon technology of ‘Acoustic Shock Wave’ known as Intravascular lithotripsy which has recently emerged as a beneficial option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres, studies are ongoing in the safety and efficacy of this technology in treating coronaries.
“An 87 years old man was admitted to BM Birla with 90 percent blocked left Main artery. His left artery was densely calcified. Since rotablation was difficult and has a higher complication rate we tried a standard technique of non-compliant and cutting balloon angioplasty at first, with an extremely high pressure but it became impossible to open such a blockage. These calcified blocks behave like hard rocks. Even if we put stents, they do not open up well causing very high chance of re-blockages. Such blockages are found in nearly 20% of the patients especially those who are elderly diabetic or have chronic kidney disease or have long-standing blockages or previous bypass surgery. Hence, we decided to go ahead with the Shockwave Coronary Lithotripsy, which is a major advancement over the previous techniques and used for such hard blockages since ultra-high-pressure balloons or rotatory drills are complex to use and carry the risk of rupturing the artery, explains Dr Mishra.
Dr. Mishra elaborates “Such blockages can now be opened with ease and safety to give patients the best results for the long term. The sonic pressure waves are produced when performing Intravascular Lithotripsy giving us a novel safe and proven treatment option to break up the calcified plaque with potentially least risk of injury to the artery compared to other treatments. The calcium 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”.
The angioplasty was successfully conducted and the patient is doing well post the procedure. He has be discharged within a couple of days from the hospital. With a hospital stay of only two days and hardly any incision or blood loss, he is back to normal life .He is extremely happy and the family is relieved.