Apollo Hospitals reports first successful use of Intravascular Lithotripsy in India in treatment of severely calcified carotid artery stenosis
New Delhi: Apollo Hospitals today announced the first successful use of Intravascular Lithotripsy in India to treat a 75-year-old male patient with heavily calcified carotid artery lesions. The patient, who presented with recurrent CVA (cerebrovascular accident) or strokes, was successfully treated by transcarotid arterial revascularisation (TCAR) using Intravascular Lithotripsy (IVL). With only a few cases reported from USA and Italy using IVL to treat carotid artery stenosis or narrowing, the achievement by the team of doctors at Apollo Health City, Hyderabad of the first reported use of this technique in India is a milestone in carotid angioplasty and stenting procedures in the country.
Dr. Sangita Reddy, Joint Managing Director, Apollo Hospitals Group said, “At Apollo Hospitals, we are always looking to set new standards of care with advanced medical technology that lets our doctors undertake challenging procedures safely and successfully. The first reported use of IVL in India to treat calcified carotid artery lesions will enable us to treat patients who cannot go in for conventional procedures. It will decrease the risk of procedural complications, providing positive clinical outcomes with reduced risk of future adverse events. It is a testament to the dedication and skill of our doctors that they have continued to focus on treating and saving lives of patients with NCDs even during the pandemic.”
Dr. P C Rath, Sr. Consultant Cardiologist & Director, Cath Lab & Interventional Cardiology, Apollo Health City, Hyderabad said, “The patient presented with recurrent strokes. Upon evaluation, he was found to have a critical stenosis involving the right internal carotid artery. There was also significant calcification of the vessel and a 180o arc of deep wall calcium. This required urgent intervention to open up the vessel since carotid artery stenosis (CAS) is responsible for around 30% of ischemic strokes. The conventional treatment option of carotid endarterectomy, that is, surgical approach to remove plaque from the artery was not recommended due to advanced age and comorbidities that included hypertension and a prior CABG (coronary artery bypass graft surgery). A direct stent implant through the minimally invasive transfemoral carotid artery stenting was also not advisable due to the severely calcified plaque that would prevent proper stent expansion with sub-optimal dilatation of the artery. It was decided to proceed with Intravascular Lithotripsy that combines the combines the calcium-disrupting potential of lithotripsy with the expertise that we hold in use of balloon catheters.”
Intravascular Lithotripsy (IVL) works through generating sonic waves, which are sonic pressure waves. This is a novel use of the concept of lithotripsy, that has been safely used for decades to treat kidney stones by safely breaking up the stones. The sonic waves in IVL pass through the soft tissues of the arterial wall lining, and the pulsatile energy safely disrupts the calcium in the plaques, creating micro-fractures in the calcium. The broken-up calcium allows expansion of the artery at low pressure thus permitting the safe implantation of a stent with minimal trauma to normal arterial tissue and improving the blood flow. The procedure is safer as the calcium fragments resulting from the IVL therapy remain in situ, with a reduced likelihood of breaking off and embolising.
Dr. P C Rath added, “A new tool called Shockwave intravascular lithotripsy that has been recently approved for the treatment of heavily calcified lesions in coronary and lower limb arteries was used to treat the heavy calcification in the carotid artery. While minimal data exists for its use in treating calcified plaques in carotid artery, we decided to proceed with IVL as the patient’s age and co-morbidites would not permit conventional treatment methods. However, the underlying calcium is known to result in suboptimal outcomes following stenting through percutaneous intervention. Aggressive post-dilatation in the carotid region often results in severe bradycardia (slowing down of heart rate) and hypotension (low blood pressure). IVL facilitated adequate stent expansion and we were able to successfully perform the dilatation with minimal residual stenosis. The patient remained clinically stable and was discharged.”