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Intravascular lithotripsy in severe calcified Ostial/proximal and tortuous LAD:

  • Dec 24
  • Cardiac Care

Case Report

A 62 year old male presented with chest discomfort. ECG showed changes suggestive of block in the blood vessels to the heart. An Angiogram was performed which revealed 80% block in main vessel supplying blood to the heart.

Traditionally this block will be removed by a balloon and a stent will be placed to prevent closure of the vessel.

In this case, the vessel was blocked by hard calcification which is cemented to the blood vessels.

The calcified block is removed by special technique like high pressure balloon rotational atherectomy laser. This technique was however not possible in this case die to technical challenges like the tortuous blocked vessels and other complications.  

Recently, IVL is approved for treatment of severely calcified plaques in coronary and peripheral arteries. This is novel therapy use balloon inflation (max 4-6 atm) using localized pulsatile sonic pressure waves; similar to lithotripsy used for kidney and urethral stone. The high-speed sonic pressure waves pass through soft vessel wall tissue and selectively disrupt subendothelial calcified plaque. The technique was previously approved and employed for peripheral vascular calcification. However, IVL recently approved (Feb 12, 2021) by the FDA to treat coronary lesions.

Post approval, real-world evidence on the performance and safety of IVL for treatment of severely calcified coronary stenosis is an unmet need. Inline, we presented a case that demonstrates the feasibility and safety of using an IVL device to treat severely calcified coronary artery stenosis with tortuosity.

Conclusion

At Fortis Hospital, Vadapalani we can extend non-surgical solutions to those who present with 80% blocks with hard calcifications in a tortuous main vessel using a novel technique Intravascular Lithotripsy. The calcification was removed safely and a stent was placed. The patient recovered well without any complications.

 

 

 

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