The interventional answer to heavily calcified coronary lesions could reside in a balloon catheter that blasts calcifications with bursts of acoustic energy, suggests doctors at Apollo Hospitals. They recommend the use of breakthrough procedure Intravascular Lithotripsy or shock wave lithotripsy to remove calcific hard blocks.
Dr. G. Sengottuvelu, India’s leading Interventional cardiologist and senior consultant at Apollo hospitals in Chennai, said that this is one of the most awaited technologies for managing the challenging calcium of coronary arteries.
The doctor and his team recently performed this procedure to open a severely blocked artery of an 81-year-old man who had high complex blocks which were very hard and calcified and conventional balloons at higher pressures failed. Dr. Sengottuvelu said the blocks in this patient were very hard and involving long segments and had to use conventional Rotational atherectony followed by Intravascular Lithotripsy the combined procedure being called ROTASHOCK or ROTATRIPSY. It has been noted that up to 20% of percutaneous coronary intervention (PCI) procedures are challenged by severe calcifications, and coronary calcifications have been shown to be an independent predictor of PCI failure and future adverse cardiac events. This is where Rotashock comes to rescue.
The new technology of Intravascular Shock wave Lithotripsy uses acoustic sonic waves to address the most challenging calcium. Pulsatile sonic pressure waves are delivered through a specialised balloon with this intravascular lithotripsy therapy which breaks up and softens calcium, without the risk of major injury to the blood vessel. This technique of lithotripsy ensures lowest risk rates including perforations/dissections unlike the conventional techniques.
In complex cases, calcium in coronary arteries resides for over years or decades and doesn’t let the conventional balloons even at extremely high pressures to dilate the lesion leading to unsatisfactory results in angioplasties performed.
With the advent of this new technology the most complex lesions with hard calcium are handled in a much simpler way with least rates of adverse events.
The technology is applied by pressing the button of a unique pulse generator which is attached to the console of the system in just 30-40 seconds. This therapy is advantageous over the existing method, as the deep calcium can be penetrated allowing the stents to expand better offering positive long-term results.
This new technology can often be used alone, and at times is combined with the existing Rotablation to modify superficial and deep calcium, where the delivery of lithoplasty balloon is not achieved. Currently, the procedure is only being done in few centres in Europe, South America and India. It would soon be introduced in the USA.
