Dr.ViabhavBiyani, Interventional Cardiologist, Nagpur
Nagpur. In our country, more than a million heart patients undergo angioplasty every year. According to statistics up to this year, the blockages found in the coronary artery of 90% of men and 60% percent of women are calcified blockages at age of 70. Till now, stenting was extremely difficult to perform in these blockages and it was difficult to implant stents in calcified lesions which could also lead to the chances of re-stenosis a great extent. But now Intravascular Lithotripsy has come up. With the help of this technique, angioplasty can be easily done in patients. So, lesions can be fully removed and stenting has now become easier.
Talking about the cause and effect of the rising levels of calcium it is discussed that excess calcium in the blood with cholesterol produces plaque, which obstructs the blood flow in the arteries causing stiffness in them that leads to strokes and heart attacks. Specific causes that might lead to Calcified Lesions in patients are Diabetes Mellitus, high Cholesterol levels, hypertension, smoking, heavy drinking, or kidney diseases.
A few observational signs suggestive of coronary artery calcium deposition and calcified lesions could be understood by identifying chest pains, shortness of breath, heaviness of the chest, dizziness, slurred speech, weakness in the hands and legs, sudden and severe headache, numbness in the leg and tightening sensation. These symptoms indicate a blocked artery to be even more precise.
Explaining the evidence of coronary arteries having calcium deposits in them is possible through tests such as a CT scan that validates the quantity of calcium in the coronary arteries in this non-invasive procedure, whereas, Computed Tomography Coronary Angiography (CTCA) detects Calcified Lesions.
Technological advancements have made the complex processes simple and less painful, bringing better treatments with not much to worry about giving productive results and cures. IVL Intravascular Lithotripsy is a new technology that uses a standard balloon catheter to circumferentially break down hard materials of calcium that limit the flow of blood in the heart.
How does the IVL work?
A small cut (incision) in the patient’s arm or leg is used to introduce the catheter to the heart. The lithotripsy emitters produce pressure waves to break up the calcification, restricting the blood flow in the heart’s arteries. Inflation of the balloon opens the blood arteries (angioplasty). Next, a stent is implanted to maintain the opened vessel after the Shockwave system has been used.
Polymer-free Stent: The new generation stents are made of cobalt chromium metal instead of polymer. These are also drug-eluting stents that release 80 percent of the drug within 28 days of implantation and in these stents, a drug called “Probucol” has been used, which will act as a polymer but will not cause problems like that. Newer metal stents are more visible after implantation in imaging-guided angioplasty such as OCT or IVUS and are more flexible than earlier polymers. New generation stents are very beneficial for diabetic patients, who are prone to re-stenosis. This new generation stent is safer and carries much better results post angioplasty. It has 10 years of data on all research and development.
