Dr. Vlad Dzavik
Dr. Vlad Dzavik (L) uses intravascular lithotripsy, or IVL, to treat a patient with advanced cardiovascular disease in a North American first at Peter Munk Cardiac Centre. (Photo: UHN)

For the first time in North America, sonic pressure waves have been used to help treat patients with advanced cardiovascular disease.

This technology, also referred to as intravascular lithotripsy, or IVL, is a similar approach to how physicians tackle and treat kidney stones, which are made up of calcium.

In the heart, calcium can be similarly problematic, where it can form in an arterial plaque blockage, creating chaos for minimally invasive angioplasty procedures: it can impair or even prevent stent expansion.

IVL, used for the first time in North America during an interventional cardiology procedure at UHN's Peter Munk Cardiac Centre (PMCC), breaks up calcium that has formed in the blockage, allowing for proper stent placement and blood flow.

The surgery to perform this novel procedure took place in November, where PMCC's Dr. Vlad Dzavik successfully used the IVL to dilate the calcified artery using minimal pressure with the angioplasty balloons, and then deliver and expand stents.

'Very encouraged' by the results

Towards the end of the procedure, the patient had increased diameter in three of his most important coronary arteries – often a sign of good outcomes.

"I'm extremely pleased with both the patient's outcomes and progress following this procedure, and am very encouraged by his results," said Dr. Dzavik.

"I'm incredibly hopeful that we can continue using this therapy on other patients."

Rob Fletcher, Vice-President of Marketing for Shockwave Medical Inc., the company that pioneered the treatment, said calcium "is the single most important predictor of poorer outcomes."

"This technology seeks to minimize trauma within the artery by delivering pulsatile sonic pressure waves locally to fracture calcium in the artery wall but pass through surrounding soft vascular tissue in a safe manner," he said.

shockwave machine
The Shockwave intravascular lithotripsy, or IVL, uses a similar approach to how physicians tackle and treat kidney stones, which are made up of calcium. (Photo: Courtesy Shockwave Medical Inc.)

There is no similar technology available currently in interventional cardiology, where heavily calcified arteries have traditionally been treated by high-pressure balloon angioplasty or an atherectomy, which is often likened to a high-speed sander inside the artery.

"These treatments, which can be difficult to perform, only address the burden of inner most layer of calcium with varying degrees of success and result in an increased risk for adverse events since these techniques don't differentiate between the calcific lesion and soft intimal tissue," Rob said.​

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