Shockwave Intravascular Lithotripsy (ivl) For Severely Calcified Coronaries

Coronary interventional innovations through the years

Coronary interventional innovations continue to push the boundaries of what we can do to help patients in a minimally invasive way. In the last 50 years, percutaneous coronary and intravascular interventions have undergone several revolutions in hardware and technique which have made the interventions safer and more effective.

For many years, the presence of significant amounts of calcium in the artery that precludes any possibility of passage of the stent has been a major stumbling block in further intervention. Many techniques have been invented, such as the use of drills (Rotablator or Orbital Atherectomy devices), cutting, scoring balloons and high-pressure balloons. Unfortunately, the devices have not been uniformly successful because of the myriad presentations of the calcium in the artery. As our stent technology gets better and better, it is important that the device is safely delivered to the required part of the artery for maximal benefit.

What is shockwave intravascular lithotripsy?

Shockwave Intravascular Lithotripsy (IVL) is the use of high pressure and transient shockwaves that crack the calcium in the artery without causing any damage to the surrounding tissue. It is a revolution in the treatment of this vexing problem that comes up frequently in our daily interventional workload. IVL has certainly ameliorated much of the angst of a failed procedure by allowing the safe passage of a stent where it is required most and ensuring proper deployment and apposition of the stent.

Why You Need Shockwave Intravascular Lithotripsy?

When coronary artery blockages – a condition which causes heart attacks and chest pain, occur, balloon angioplasty and stenting is a good option for treatment. Unfortunately, if the artery has heavy calcium deposits, this then prevents the balloon from dilating it properly. If the balloon cannot dilate the vessel, the stent will not be able to be fitted properly. This can and will cause failure, and re-blockage of the coronary artery.

In coronary shockwave therapy, a special balloon fitted with transducers is carefully placed into the artery where the calcium is causing the obstruction. Once the accurate placement is confirmed, the transducers are fired, and transient shockwaves permeate through the artery. The beautiful aspect of this procedure is that the shockwaves are hard on calcium causing them to crack and be pulverized.

The surrounding soft tissue is thankfully spared as the shockwave passes through it without any collateral damage. Hence, this futuristic technology does its job where it is needed the most and spares normal tissue. It is like a "Smart Shockwave". Indeed, the whole concept of treatment is in keeping with the adage "treat what is needed and spare the normal"

Once the calcium has been adequately softened and shattered, it is a small matter to now pass the stent through to the target area in the coronary and deploy it at optimal pressures. This will then ensure that the stent will last long, and the patient not burdened with a problematic re-stenosis. The procedure is fast, simple and the patient can resume his activities almost immediately. 

Coronary shockwave is a miniaturized version of the familiar shockwave technology which is used in pulverizing kidney stones so that they can be passed safely in the urine and not cause any obstruction or pain.

Due to its safety and effectiveness, this method has been effectively utilized in urology for years without significant long-term consequences, and its application in cardiology has been met with enthusiasm for its safety and efficacy.

A severe calcified blockage of the left anterior descending coronary artery successfully cracked with IVL then stented with excellent results in our centre.