• June 24, 2022
• By admin

Is removing arterial calcification as easy as removing kidney stones?

Arterial calcification puts the heart at risk:

Until now, it was believed that coronary artery calcification was a benign condition that worsened with age. The association between medial calcification and arterial stiffness, which raises the risk of unfavourable cardiovascular events, was later found by investigations. Further research revealed a strong correlation between the degree of atherosclerosis and the likelihood of future cardiac events, and percutaneous coronary intervention (PCI) is challenging to perform in patients with coronary heart disease (CHD) due to the high prevalence of coronary artery calcification (CAC). Age and the presence of cardiovascular risk factors and comorbidities both raise the degree of coronary artery calcification. Coronary calcifications have been proven to be an independent predictor of PCI failure and subsequent adverse cardiac events, posing a challenge to up to 20% of percutaneous coronary intervention (PCI) procedures. Procedure complexity and duration are increased by lesion calcification. A procedure’s success, stent delivery, and deployment are especially influenced by calcium localization (superficial or deep), distribution (focal, circumferential, and longitudinal extension), and thickness. High-pressure and super-high pressure non-compliant balloons, cutting/scoring balloons, atherectomy devices, both rotational and orbital, and excimer lasers are some of the treatment options for calcified lesions in native coronary arteries. These devices, which rely on tissue debulking and/or tissue compression, are more likely to result in procedural complications including dissections, perforations, and distal embolization. Additionally, when deep, thick, or eccentric calcifications are present, their success rate is decreased, and the resultant tissue injury may hasten unchecked neointimal development and restenosis. Specialty balloons and atherectomy tools haven’t yet been shown to provide better clinical results than high-pressure, non-compliant balloons. Recently, an alternative technique for disrupting calcium that is based on the lithotripsy technique used to treat kidney and ureteral stones has been devised.

What is Intravascular Lithotripsy (IVL)?

With the help of the Intravascular Lithotripsy (IVL) System, low-pressure balloon inflation converts electrical energy into mechanical energy. While improving artery compliance, the technology uses sonic waves instead of direct vascular tissue injury to break both superficial and deep calcium deposits with little to no soft tissue damage. Sonic waves are transmitted through a balloon-based catheter to the surrounding tissue. Currently, the use of IVL is restricted to the modification of calcified plaque within the intrinsic coronary and peripheral artery vasculature; however, mounting data suggests that the device may also be helpful for aiding treatments of the main aortic arch, distal abdominal aorta, and iliofemoral vasculature for facilitating large bore access and therapies including transcatheter aortic valve replacement, endovascular aneurysm repair. The use of IVL in unusual clinical scenarios like chronic complete occlusion, unprotected left main calcified stenosis, and calcium-related stent under expansion is being researched. Calcified coronary lesions can seriously impede percutaneous procedures; these difficult plaques are often treated with high-pressure balloon expansion and sometimes atherectomy. However, it is well known that these treatments do not effectively target all lesions. In comparison to earlier balloon-based interventions, IVL offers a number of benefits, including the device doesn’t require additional training and can be used by the majority of interventional cardiologists; the balloon opening pressure is low, lowering the risk of vascular injury; circumferential plaque targeting; and a reduction in bias when the guidewire is passed.

FDA-approved Shockwave Intravascular Lithotripsy:

The Shockwave C2 Coronary IVL Catheter, IVL Connector Cable, and IVL Generator make up the Shockwave Intravascular Lithotripsy (IVL) System with the Shockwave C2 Coronary IVL Catheter. The catheter is a tube-like apparatus known as a balloon catheter with built-in lithotripsy emitters that can dislodge hard substances (calcification) that obstruct blood flow to the heart. By making a tiny cut (incision) in the patient’s arm, the doctor can insert the catheter into the heart. The goal of the pressure waves produced by the lithotripsy emitters at the catheter’s tip is to dislodge the calcification that is obstructing the blood flow in the heart’s arteries. When the balloon is inflated, this aids in widening the blood arteries (angioplasty). A separate device called a stent, which is a metal tube that helps maintain the artery open, will be implanted by the physician after the Shockwave system has been used. Before inserting a stent, the coronary arteries that provide blood to the heart (coronary arteries) that are narrowed or obstructed due to calcification are opened using the shockwave C2 Coronary IVL Catheter.

Reference:

Butt, N., Khalid, N., & Shlofmitz, E. (2022). Intravascular Lithotripsy. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK560548/

Forero, M. N. T., & Daemen, J. (2019). The Coronary Intravascular Lithotripsy System. Interventional Cardiology Review, 14(3), 174–181. https://doi.org/10.15420/icr.2019.18.R1

Health, C. for D. and R. (2021). Shockwave Intravascular Lithotripsy (IVL) System with the Shockwave C2 Coronary Intravascular Lithotripsy (IVL) Catheter – P200039. FDA. https://www.fda.gov/medical-devices/recently-approved-devices/shockwave-intravascular-lithotripsy-ivl-system-shockwave-c2-coronary-intravascular-lithotripsy-ivl

Kereiakes, D. J., Virmani, R., Hokama, J. Y., Illindala, U., Mena-Hurtado, C., Holden, A., Hill, J. M., Lyden, S. P., & Ali, Z. A. (2021). Principles of Intravascular Lithotripsy for Calcific Plaque Modification. JACC: Cardiovascular Interventions, 14(12), 1275–1292. https://doi.org/10.1016/j.jcin.2021.03.036