Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-023
Shockwave Therapy in Calcified Lesion
By Punish Sadana
Presenter
Punish Sadana
Authors
Punish Sadana1
Affiliation
Max Super Specialty Hospital, India1,
View Study Report
TCTAP C-023
CORONARY - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Shockwave Therapy in Calcified Lesion
Punish Sadana1
Max Super Specialty Hospital, India1,
Clinical Information
Patient initials or Identifier Number
VKG
Relevant Clinical History and Physical Exam
A 79 Year old male a known case of hypertension,Diabetes mellitus presented with complaints of chest pain on exertion for 2-3 months ,increased for 1 week before admission and breathing difficulty for 1 day.on examination :Pulse rate 98/min,BP 126/64mmhg. Chest-b/l basal crepts+,CVS s1s2 normal,JVP raised.ECG-st-t changes in anterior leads,Echo:RWMA in LAD territory,LVEF 35%Paient was diagnosed as Acute coronary syndrome and LVF.
Relevant Test Results Prior to Catheterization
ECG-ST-T changes in anterior leadsEcho:RWMA in LAD territory,LVEF 35%Troponin +ve
Relevant Catheterization Findings
CAG revealed Double vessel disease:LAD densly calcified 80-90%stenosis from proximal-mid LAD,osteal and mid RCA 80%stenosis
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Procedural Step
Patient was planned for PTCA/Stent to LAD using IVL as lesion seems to be densly calcified(superficial and deep).Left coronary artery was hooked with 6F EBU 3.5 guide catheter,Runthrough guidewire crossed across the lesion.Lesion predilated with 2x12mm upto 16 atm and 2.5x12mm balloon upto 16 -18 atm .Thereafter 3x12mm IVL balloon used to give 80 ultra sonic pulses starting from mid to proximal LAD.3X33mm DES deployed followed by postdilation with 3x12mm NC balloon upto 18 atm with good TIMI III flow.
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Numerous techniques are available for treating calcified lesions like non-compliant high pressure balloons, scoring/cutting ballons, Rotational/orbital atherectomy, excimer laser. These procedures have significant number of complications like distal embolisaion/dissections and depends upon tissue compression and debulking.There success rate decreases with presence of deep calcium.
The IVL system during low pressure inflation transforms electrical energy into mechanical energy which safely break superficial and deep calcium leading to plaque modification.
IVL(intravascular lithotripsy) has less chances of dissections and perforation.