SHOCK-WAVE INTRA ARTERIAL LITHOTRIPSY for Calcific Coronary Artery Disease.

Shock Wave Intra Arterial Lithotripsy in a patient with Ischemic Cardiomyopathy, acute decompensated heart failure and cardiogenic shock. The purpose is to demonstrate the use of Newer emerging Technologies in the management of difficult complex coronary artery blockages.

Brief history octogenarian admitted in acute decompensated heart failure, bi pedal edema. Comorbidities Hypertension, obesity, obstructive sleep apnea, ischaemic cardiomyopathy and Lacunar stroke (CVA). Reformed smoker, chronic obstructive pulmonary disease, acute kidney injury, old tuberculosis. Bedside pre-ionotrope LV ejection fraction 20%, severe pulmonary hypertension, diastolic heart failure. Post Ionotropes  improved to 24 to 27%. During stay episodes of intermittent, atrial fibrillation, metabolic alkalosis, non cirrhotic hyper-ammonaemia. Patient was not coming of ionotropes,  hence with high risk DOT consent angiography done which showed Infarct related LAD legions, near-normal left circumflex, dominant Right coronary artery showing critical proximal calcific stenosis and distal lesions.

Heart team Ideally Bypass surgery which Surgeon refused in view of high mortality and morbidity both intra and post operative. After 2 days decided to tackle critical proximal calcific right coronary artery as culprit lesion. We have rotablator but in view of tortuosity and bend there was high risk of perforation hence decided phone Shock Wave Medical USA

Shock-Wave Intravascular Lithotripsy is a very safe effect device for Debulking. It not only Debulks superficial calcium but is also the only device that debulks Deep and Medial calcium.

MECHANISM:  Shockwave has two Emitters on the shaft of the shockwave catheter at a distance of 6 mm. A  3KV current is given out from the shockwave console and transmitted onto the shockwave catheter’s shaft.  Once the Emitter receives the current and the balloon is inflated 4 Atmospheres, the Emitter starts  Ionizing &  Vaporizing the Contrast + Saline solution in the balloon, which sets an Acoustic Wave. This pressure of 4 atmospheres applied from the inflation device is converted to 50 atmospheres pressure outside of the balloon & is transferred into the Intima and also the and the Media.

Shockwave operates on the principle of Hard on Hard and Soft on Soft.  These Acoustic waves fracture only calcium or Hard Surfaces & do not affect the normal tissue. That is why SHOCK WAVE INTRA VASCULAR LIPHOTRIPSY  is very safe and does not cause Perforation, Dissection besides No  Slow -Flow or No-Reflow thus making it State of art Technology from Shock Wave Medical USA.

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