What’s good for the kidney is good for the heart

For decades, lithotripsy has helped break up kidney stones in some people by using ultrasound shock waves.

This procedure now is available at Silver Cross Hospital in New Lenox for patients with severely calcified coronary artery disease. The procedure is called intravascular lithotripsy.

Dr. Hong Jun “Francisco” Yun and Dr. Christopher Bane, interventional cardiologists with Heart Care Centers of Illinois, performed the first two procedures March 8 at Silver Cross, according to a news release from the hospital.

Both patients were male and in their early 70s, had their procedures in the morning and went home the same day. Yun said the goal always is to treat coronary artery disease safely and effectively, and intravascular lithotripsy gives another option for doing just that.

“This newer technique is now available for us to help manage people that we, historically, had difficulty treating,” Yun said.

People with coronary artery disease have plaque that builds up in their arteries, so doctors often place stents into those arteries to reopen them, Yun said. But in some patients, that plaque can turn into calcium deposits that can be soft or hard, rigid and calcified, Yun said.

But it’s challenging to reopen those arteries in patients with calcified coronary artery disease, Yun said. That’s because these calcium deposits narrow the artery, making it rigid and resistant to reopening with either balloon or atherectomy treatments, especially if the lesion is severely calcified, Yun said.

“If the lesion is severely calcified, then it’s hard to respond to our stents,” Yun said.

According to the Silver Cross release, about 1 million people in the U.S. undergo a stent procedure each year to open narrowed arteries. And 30% of these people have “problematic calcium that increases their risk for adverse events.”

In the past, these patients had two options to remove that calcium so their stents could be placed. One option uses balloons, inflated to high pressure, to crack the calcium, the release said.

Another option is atherectomy, a treatment that shaves away the calcium and opens the artery, according to the American Heart Association. But atherectomy is challenging to use and can lead to complications such as tears in the vessels, Yun said.

“Atherectomy also has a steep learning curve compared to balloon-based techniques,” Yun said in an email.

But with intravascular lithotripsy, doctors can use sonic pressure waves to fracture the calcium deposits. Then doctors can safely expand the artery and place a stent to restore blood flow, Yun said.

In fact, intravascular lithotripsy is a balloon-based procedure, Yun said.

“Because it is a balloon-based technique, it does not add significant time to the procedure compared to traditional angioplasty and many patients go home the same day,” Yun said in the email. “There are no special precautions post procedure compared to the usual angioplasty. Once IVL is performed, it does not necessarily need to be repeated as the area of stenosis is treated with a stent, unless a new lesion forms.”

However, intravascular lithotripsy can also open up calcified vessels in other areas, such as the legs. Yun said.

Last week Yun performed a minimally invasive aortic valve replacement – a TAVR – on a patient. TAVR, which stands for transcatheter aortic valve replacement, can performed through a small incision in the chest or through the femoral artery, according to the American Heart Association.

“I used the shock wave balloon to open up the area of blockage in the vessels in the leg to allow us to take up the valve and do the minimally invasive valve replacement,” Yun said. “I think it’s a cool point that we can use this technique in various modalities to treat the patient.”

For information, visit shockwavemedical.com/IFU and silvercross.org/heart.