Team of doctors at Yatharth Hospital, Noida Extension performed the Intravascular Lithotripsy to open a severely calcified blocked artery in a 91 years old diabetic patient, who had a heart attack.
The patient was diagnosed with Inferior wall MI (myocardial infarction) and blockages in the major three vessels of the heart. He had 90% blockage in the right coronary artery (RCA) and left anterior descending artery (LAD), and 75 % blockage in the left circumflex artery (LCX), out of which LAD and LCX were having calcified disease. Considering the factors such as age and comorbid conditions of the patient, it was decided to take him for angioplasty of culprit RCA disease and staged angioplasty (PTCA) to LAD with Intravascular Lithotripsy (IVL). Shockwaves were given inside the artery to break down the calcium deposits before placing stent in LAD vessel. The patient was sent home happily after two days of the procedure.
“In some patients, there are hard calcium deposits encapsulating the arterial segment, with critical narrowing, which doesn’t allow the stent to expand properly. These types of lesions require plaque modification techniques, for example, Scoring balloon, Rotablation (drilling with diamond), and IVL. Once the calcium is fragmented with IVL, the artery is opened up easily with the help of ballooning, and a stent can be optimally placed in it”, said Dr Krishan Yadav, Interventional Cardiologist, Yatharth Hospital, Noida Extension.
Lithotripsy was originally invented and used for the treatment of kidney stones, to eliminate the obstructions without surgery. Now the technology is being used in coronary vessels to afford a safe treatment for calcified lesions in arteries, the cases which were historically complicated to treat.
Mr. Yatharth Tyagi, Director, Yatharth Group of Hospitals said “This is yet another occasion when our experienced team of cardiologists has performed a novel procedure to improve upon the results of treatment and provide better patient experience. We are sure that the new technology will be beneficial in saving more lives in the future”.
For another case of 78-year-old male patient, having complaints of chest discomfort and shortness of breath, the Intra-vascular ultrasound (IVUS) technique was used to quantify the blockages post PTCA and stenting, in which Coronary Angiogram suggested the left main disease. IVUS showed significant In-stent restenosis (ISR) in the LAD stent without significant blockage in the left main artery, which was falsely seen on angiography.
IVUS is an advanced technique that overcomes the limitations of two-dimensional images through an angiogram, thus generating detailed imaging of the coronary arteries. This helps in the assessment of the severity and texture of plaque inside arteries, stage of the disease, and length of the segment to be stented, which is critical to determining the treatment and deciding whether an angioplasty or bypass surgery is necessary for the patient. The Imaging-guided angioplasty (IVUS/OCT) helps improve long-term results, without too much addition to procedural time and complexity.