Innovative shock wave therapy for heart disease

Heart disease is the leading cause of death Worldwide as well as in the UAE. As medical technology advances, interventional cardiologists in Dubai are now equipped with more and more minimally invasive catheter-based tools to help treat complex heart diseases that otherwise would of needed major heart surgery.

Dr Khaled Awad, cardiac electrophysiologist and interventional cardiologist and Dr Yasir Parviz, interventional cardiologist, reflect on a recent complex case of calcified coronary heart disease at Clemenceau Medical Center Hospital Dubai that they jointly conducted in the Catheterisation laboratory.

Dr Khaled explains: “A 65-year-old smoker visited their clinic with chest pain (source unclear), shortness of breath, and uncontrolled cholesterol. A past angiography conducted 5 years ago in the UK confirmed heart disease, but the patient had stopped medication, leading to rising blood pressure and cholesterol. We needed to evaluate for potential coronary disease progression."

Calcified Coronary Heart Disease

Dr Khaled added that the patient's case was more complex than a standard Percutaneous coronary intervention (PCI). A CT scan revealed extensive calcification in both the left anterior descending (LAD) and left main coronary arteries (LCAs). The patient's age and smoking history further complicated matters, suggesting conventional ballooning/PCI was unlikely to suffice. “Despite this, we initially attempted the standard approach during the procedure to crack the stenosis, but as anticipated, it proved unsuccessful,”, added Dr Khaled.

Conventional ballooning techniques also known as percutaneous coronary intervention (PCI), is a minimally invasive procedure that widens narrowed or blocked arteries in the heart. A thin, flexible tube with a balloon at the tip is inserted into the artery through a small incision in the groin or arm and guided to the blockage. The balloon is then inflated to open the artery and improve blood flow.

Also, due to the vicinity to the LCA, the dissection (a tear in the coronary artery) which commonly happens while cracking the calcifications, is better controlled with IVL than with aggressive ballooning. If the dissection/tear propagates to the LCA this makes the procedure way more hazardous.

Intravascular lithotripsy (IVL) is a technique used in interventional cardiology, specifically for the treatment of calcified coronary artery disease.

How does Intravascular lithotripsy (IVL) Work?

Dr Yasir explains that IVL is a catheter-based system that uses sonic pressure waves to disrupt and modify calcified plaque within coronary arteries. The IVL Procedure is safe and effective. Dr Yasir describes how it is performed via the following steps:

• “We take the IVL catheter within the coronary artery at the site of calcified plaque. We position and inflate the balloon, pressing the lithotripsy emitters against the calcified lesion.

• The lithotripsy generator produces sonic pressure waves to create microfractures in the calcified plaque.

• After delivering the sonic waves, the balloon is deflated, allowing for improved blood flow through the dilated artery.

• Stent placement will then happen.

• Post-Procedure Monitoring – patients will be monitored for a short time to ensure no adverse events.”

The angiogram image on the left clearly shows restrictions in the heart’s blood flow as indicated by the arrows. These were the result of the severe calcified narrowing in the arteries. The image on the right shows the blood flow after the IVL procedure which has clearly improved as no blockages are present anymore.