For decades, shock waves have been used to break up kidney stones. Now that same technology is being used to break up calcium deposits in heart vessels of patients undergoing stent replacement.
MUSC Health is among the first in South Carolina and the first in the Pee Dee using the new technology, known as intravascular lithotripsy, (IVL). Approved by the U.S. Food and Drug Administration in early 2021, IVL uses sonic pressure waves to fracture stubborn calcium deposits and safely open arteries in patients with coronary artery disease so a stent can be inserted to restore blood flow.
Dr. Gregory May, an MUSC Health Florence interventional cardiologist, says the new technology is a promising option for patients who have calcium buildup so thick that it is resistant to conventional treatments such as inflatable balloons and atherectomy. Balloons have been used to crack the calcium when inflated to high pressure, and atherectomy, which involves drilling through the calcium, carry the risk of perforation or vessel damage, May says.
IVL is a big advancement in these types of cases with less vessel damage compared with atherectomy,” says May, who has been using the new technology since March. “It is a very safe, straightforward and effective treatment for dealing with calcified vessels, and it takes less time and carries a lower risk of damage to the blood vessel or of coronary perforation.”
In IVL, a balloon catheter is attached by a cable to a small console about the size of a college textbook. Using guided imagery, MUSC Health cardiologists insert the catheter into the patient’s wrist or groin and threads it to the calcified artery. Once the balloon reaches the target area, it is inflated and the shockwave device is activated by the cardiologist. Each area receives a total of 80 seconds of sonic pulses, or 8 runs of 10 seconds each. The sonic pulses fracture the calcium in the arterial wall, making the artery less stiff and allowing a stent to be advanced and fully expanded at the original blocked area.
“The calcium in the vessel wall is not removed; it stays in the wall but is broken up, making the artery more flexible and allowing stents to be more easily advanced down the vessel and fully expanded to restore blood flow,” May says. “The procedure takes about an hour and most patients are discharged home the same day.”
May says IVL is particularly valuable to patients in the Pee Dee, many of whom have severe blockage along with severe calcium build up likely the result of smoking, unhealthy diets, hypertension, diabetes, and high cholesterol.
“IVL is a promising technique in patients who have been the most difficult to treat with stents in the past,” he says. “It is a true game changer in interventional cardiology. Cardiac disease is the number one cause of death in the United States, with approximately 690, 000 deaths in 2020. Half of these cardiac deaths are sudden, and the majority have severe coronary blockage.
Our team at MUSC Health is committed to doing all we can in the Pee Dee to reduce the number of deaths from heart disease.”