Intra Vascular lithotripsy in calcified coronaries.pptx

calcified coronaries requires Intravascular lithotripsy treatment whenever feasible. This is a easy procedure with effective result.

1. INTRAVASCULAR LITHOTRIPSY (IVL) DR.K.ANTONY WILSON Md, DM. INTERVENTIONAL CARDIOLOGIST APOLLO MAIN HOSPITAL

2. Introduction The amount of coronary artery calcification increases with age and the presence of cardiovascular risk factors and comorbidities. Up to 20% of PCI procedures are challenged by severe calcifications. coronary calcifications have been shown to be an independent predictor of PCI failure and future adverse cardiac events.

3. Techniques for calcified lesions High-pressure and super-high pressure non-compliant balloons C utting/scoring balloons A therectomy devices, both rotational and orbital E xcimer lasers Tissue compression and or tissue debulking H igher rates of procedural complications, such as dissections, perforations and distal embolization. S uccess rate reduced with deep, thick or eccentric calcifications Induced tissue injury might accelerate uncontrolled neointimal growth and restenosis

4. Intravascular lithotripsy (IVL) ( Litho-stone; tripsy -break) H as emerged as a novel therapy for the treatment of vascular calcification. IVL is based on the established therapeutic strategy of using acoustic pressure waves to treat renal calculi . Intravascular lithotripsy ( IVL )

5. Mechanism IVL emitters produce electric sparks that create vapor bubbles in the surrounding fluid medium within the integrated balloon. I VL produces low levels of electric energy, which leads to the formation and rapid expansion of vapor bubbles, which result in acoustic pressure waves that radiate circumferentially and transmurally in an unfocused manner The leading edge of the shockwave imparts compressive stress once calcium is encountered and is the primary mechanism of calcium fracture with IVL. D eliver tissue-safe positive (50atm) and minimal peak negative(-3atm) pressure pulses-less tissue injury.

6. Steps of Use

7. • Arc >180 • Length > 5 mm • Thickness > 0.5 mm

8. Shocktopics

9. Advantages of IVL Low Risk of Perforation Able to keep buddy wire Can modify calcium in large vessel Ability to Impact Deeper, Medial Calcium Ability to Navigate Tortuous Anatomy No wire bias Low risk of dissection

10. CASE 1 :A 69 years old male DM, DLP, Post PTCA to LAD (7years ago),Effort angina,LVEF-46%

11. 3.5x12mm shockwave C2 IVL ballon

12. CASE 2 : A 52 years old female HTN, DM, obese, DLP, S/P CABG(LIMA-LAD)-2016,Now effort angina for 3weeks, Normal LV function

13. 0.75x10mm Alveo HP balloon

14. 1.25mm Rota burr

15. 2.5x12mm Shockwave C2 IVL balloon

16. CONCLUSION The Coronary IVL System is a promising new treatment modality to tackle moderate to severe calcified coronary lesions, with a high rate of success and a low risk of complications.

17. THANK YOU