Cardiologists at Hackensack Meridian Hackensack University Medical Center and Hackensack Meridian Jersey Shore University Medical Center are now using leading-edge technology, Intravascular Lithotripsy (IVL), to treat atherosclerosis. IVL uses sonic pressure waves, also known as shockwaves, to create a series of microfractures to break up calcium in blood vessels that support the heart.
“The beauty of this technology is that it attacks the calcium but leaves the healthy vessel wall alone, explains interventional cardiologist Haroon Faraz, M.D., Hackensack University Medical Center. It’s based on the same technology that has been used for decades to safely break up kidney stones. It is done minimally invasively under local anesthesia, and in conjunction with angioplasty and stenting. First, the physician introduces a catheter to the heart through a small incision in the patient’s arm or leg. Then, IVL emits pressure waves to break up the calcium deposits.
Atherosclerosis, sometimes called “hardening of the arteries,” is a major contributor to heart disease and occurs when fat, cholesterol, and other substances build up in the walls of arteries. For many years, physicians have had two ways to open narrow, hardened arteries supplying blood to the heart. In angioplasty, a balloon is inflated to help open a blocked artery, and in atherectomy, tiny rotating blades open the artery through scraping and drilling. After one or both of these procedures are completed, as part of a procedure in a cardiac catheterization lab, a tiny mesh metal tube, called a stent, helps to keep the vessel open.
These methods, however, are not ideal for some patients. “Sometimes fatty plaque that has been there for so long goes from being soft and squishy to being hard as a rock, said cardiologist Daniel Kiss, M.D., Jersey Shore University Medical Center. “Because the calcium is hard, plaque can’t move back against the arterial wall, the balloon used during angioplasty can’t expand properly, and the blockage remains.
“In atherectomy, for example, when you scrape the wall of the artery, the debris that falls out goes downstream into the microcirculation, said Dr. Faraz. Physicians have to scrape enough calcium to unblock the artery, but not so much that they’ll clog the system with the debris. “Until now, there really wasn’t an optimal treatment to clear the way for the stent in those whose calcium had gotten hard and built-up, Dr. Kiss added.
“One big advantage of the shockwave is that you’re not throwing the debris anywhere, says Dr. Faraz. After the IVL creates fractures in the calcium, the artery can successfully be expanded at low pressure with the angioplasty balloon, then the stent can be implanted.
“This procedure allows us to get the biggest, most appropriate stent placed, that we are able, the first time. That should help prevent patients from having to come back to the cath lab in the future. It’s really about getting the right result in the right patient the first time, said Dr. Kiss.
“IVL is a good example of how we, as a network, equip our talented physicians with state-of-the-art clinical technology so that they can provide our patients with the best care and services, said Elizabeth A. Maiorana, MBA, MSN, R.N., CCCC, vice president, Hackensack Meridian Health, Cardiovascular Care Transformation Service.