February 19, 2020

By pass surgeries can now be prevented with advanced minimally invasive procedure

Dr Ashok Seth
While heart attacks are constantly affecting lives of many leaving them with complex morbidities, only bypass grafting remains the last resource for them. But with recent advancements in the field of cardiac sciences, advanced minimally invasive therapies have revolutionized the treatment module and outcomes even in the most critical blockages, eliminating the need for a bypass surgery.

Coronary shockwave Lithotripsy is one such advancement available in India for the first time. Fortis Escorts Heart Institute recently introduced this technique in India for the first time by successfully operating a 67 year old patient having over 90% blockage.

What is the technique?
Shockwave Coronary Lithotripsy is a novel procedure which brings hope for those suffering from an advanced form of coronary artery disease (CAD) having angina or heart attack in which the blockage becomes very hard due to deposit of calcium.This happens in 20-25% of the patients undergoing angioplasty and stenting especially those who are old, diabetic, have chronic kidney disease, have long standing blockages or who have undergone previous bypass surgery. Shockwave Coronary Lithotripsy is a major advancement over the previous techniques used for such hard blockages like ultra-highpressure balloons or rotatory drills which are difficult to use and carry risk of rupturing the artery.

Intravascular Lithotripsy launched by Shockwave Medical, USA is an innovative technology that generates sonic pressure waves within heart arteries to break up problematic calcium deposited blockages so that the blocked artery can be opened with ease and safety and blood flow restored with the placement of a stent. The therapy leverages a similar minimally invasive approach that has been embraced by physicians for decades to treat kidney stones, which are also made up of calcium.

Hardened calcified blockages are a big challenge to treat by angioplasty and stents and is getting commoner. Such blockages can now be opened with ease and safety to give patients the best
results for long term. The sonic pressure waves produced when performing Intravascular. Lithotripsy give us a novel, safe and proven treatment option to break up the calcified plaque, with potentially less risk of injury to the heart artery and safer to the patient when compared to other treatments.

Calcium slowly develops and progresses to its hardened, bone-like state over the course of several decades of cellular growth and death in diseased plaque within the heart arteries. While it is slow to develop, its impact is immediately encountered when performing procedures in calcified lesions. The calcium’s hardened structure restricts normal artery movement and makes the rigid arterial tissue resistant to traditional balloon therapies that have been designed to compress the plaque within the artery wall to restore normal blood flow. For these reasons, the presence of calcium increases the complexity of most cases and decreases the effectiveness of most treatments.

( The author is Chairman, Fortis Escorts Heart Institute(FEHI), New Delhi. Views are his own)

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