Coronary Lithoplasty: Shockwave Lithotripsy for the Coronaries

Abstract

Calcified coronaries are always the nightmare of the interventional cardiologist. They cannot be easily dilated by balloon angioplasty and balloons might rupture while high pressure inflation is attempted, leading to coronary dissections and even perforations. Our Urology colleagues have been using extracorporeal shockwaves to fragment renal stone for over a quarter century. Some researchers have used a much lower energy version these shockwaves to treat coronary artery disease which is not amenable to percutaneous coronary intervention or coronary artery bypass grafting with variable success. But these are extracorporeal shockwaves with the shockwaves applied from outside the body using a water cushion. Though they can target specific regions of the heart using echocardiographic guidance, they cannot target specific lesions within the coronaries. Coronary lithoplasty denotes the use of shockwaves delivered within the coronary artery using a specialised balloon catheter.