Introduction:
An independent predictor of significant cardiovascular events is coronary artery calcification (CAC). Coronary calcium deposition can also make it more difficult for a catheter to pass through a calcified lesion, cause coated drugs to separate from stents, increase the risk of in-stent restenosis and stent thrombosis, and alter the underlying pharmacokinetics. These are just a few of the ways that coronary calcium deposition can make PCI (percutaneous coronary intervention) less successful. Therefore, PCI of calcified lesions is associated with less favorable results.
Shockwave intravascular lithotripsy (SIL) uses a percutaneous device to generate acoustic pressure waves that deliver energy to break both superficial and deep calcium deposits and help with the deployment of a vascular stent later on. It is a novel technique that developed from the well-established treatment for renal and ureteral calculi.
What Is the Shockwave Intravascular Lithotripsy?
A minimally invasive medical treatment called shockwave intravascular lithotripsy (SIL) is used to dislodge calcified plaque from blood arteries. To compress the calcified plaque against the artery wall during the treatment, a specialized catheter with a balloon at its tip is used. After that, the catheter releases low-energy shockwaves that penetrate the balloon and disintegrate the plaque. The use of SIL for the treatment of coronary artery disease (CAD) and peripheral arterial disease (PAD) is also being studied. SIL is a potential new therapeutic option for people who have calcified plaque in their blood arteries, and it may provide such people fresh hope if their other treatment choices are limited because of the presence of calcified plaque.
What Is PAD?
Peripheral arterial disease is referred to as PAD. It is a common cardiovascular disorder in which blood flow to the limbs is decreased, usually to the legs. The illness is brought on by a buildup of plaque in the arteries, particularly calcium deposits, which causes constriction or blockages. Leg discomfort, cramping, weakness, or numbness are just a few of the symptoms that can be brought on by PAD, especially when exercising or walking. It may also raise the chance of complications like a heart attack and stroke. Medical operations like angioplasty, atherectomy, or SIL to remove or break up the plaque may also be used as part of PAD treatment. Lifestyle improvements, including exercise and a balanced diet, may also be used.
What Is the Procedure for Shockwave Intravascular Lithotripsy?
There are multiple steps in the Shockwave Intravascular Lithotripsy (SIL) procedure:
- Anesthetics: The patient will often undergo local anesthesia before the surgery to numb the region surrounding the artery where the catheter will be placed. Sedation may also be administered to the patient to aid with relaxation.
- Catheter Insertion: During the SIL operation, a tiny skin incision is made, through which a specialized catheter is inserted into the artery. The calcified plaque is compressed against the artery wall by the catheter's tiny balloon tip, which is inflated.
- Delivering Shockwaves: After the balloon is inflated, the catheter sends low-energy shockwaves to the calcified plaque to dislodge it. The shockwaves strike the plaque while traveling through the balloon, shattering it into smaller pieces.
- Removal of Plaque: After the plaque has been dislodged, it can either be drained through a catheter or absorbed by the body's natural mechanisms. To open the artery and enhance blood flow, further operations like stenting or angioplasty may be necessary in some circumstances.
- Care Following the Surgery: The patient will be observed for a short time after the treatment to make sure there are no issues. The majority of patients may resume their regular activities in a few days. However, others might need more time to heal.
What Are the Advantages and Disadvantages of Shockwave Intravascular Lithotripsy?
Shockwave Intravascular Lithotripsy (SIL) offers benefits and drawbacks, much like any medical therapy. Here are some of the most important ones:
A. Advantages:
1) Minimally Invasive: In comparison to more invasive surgical procedures, SIL is a minimally invasive procedure, which means that it is less traumatic and requires less time to recover.
2) Effective: It has been demonstrated that SIL is successful at reducing symptoms in patients with peripheral artery disease, improving blood flow, and dissolving calcified plaque in blood vessels.
3) Versatile: SIL is effective in treating a variety of calcified plaque in blood arteries, including severely calcified lesions that may be challenging to treat with other techniques.
4) Safe: The risks associated with SIL are modest, and most patients may resume their regular activities within a few days.
B. Disadvantages:
1) Limited Research: Although early trials on SIL showed encouraging results, additional study is required to evaluate the usefulness and safety of SIL over the long run.
2) Cost: SIL is a relatively new technique; thus, its price may be higher than that of other available treatments.
3) Limited Accessibility: SIL is not currently generally accessible and may only be provided in hospitals or specialized medical facilities.
4) Use Restricted: SIL may not be appropriate for all individuals, and some may need additional therapies like surgery or medicine.
How Effective Is Shockwave Intravascular Lithotripsy?
Shockwave Intravascular Lithotripsy (SIL), a therapy for peripheral artery disease (PAD) brought on by calcified plaque in blood arteries, has shown to be a successful choice. The degree and location of the calcified plaque, the patient's specific health state, and medical history are all variables that affect how successful SIL is.
Early research has shown that SIL has a high rate of effectiveness, with many patients reporting improvements in blood flow and symptoms. In the case of treating calcified lesions in the femoropopliteal artery, a 2019 research published in the Journal of the American College of Cardiology demonstrated a procedural success rate of 89.5 percent and a 12-month primary patency rate of 88.8 percent. Similar treatment success rates for calcified lesions in the iliac artery were observed in a subsequent investigation that was published in Cardiovascular Revascularization Medicine in 2020.
Conclusion:
A potential therapy option for individuals with peripheral arterial disease (PAD), which is brought on by calcified plaque in blood arteries, is shockwave intravascular lithotripsy (SIL). To completely comprehend the SIL's long-term efficacy and safety, additional study is necessary. Overall, the development of SIL in the field of interventional cardiology is intriguing since it provides patients with calcified plaque in blood arteries with a potentially efficient and less invasive therapy alternative.
