Calcification (deposition of calcium) of the blood vessel wall is part of atherosclerosis process in coronary artery disease. It is often seen in patients who have diabetes, renal failure and the elderly. Heavily calcified coronary artery can present a unique challenge during angioplasty.
Calcium is found in bones and teeth, it is the strongest element in our body. A heavily calcified and blocked artery may be too hard for the angioplasty balloons to crack them open and expand the narrowed artery. A lot of these patients are referred for coronary bypass surgery for this reason.
Coronary artery treatment in the form of coronary atherectomy refers to a highly specialised interventional technique to overcome these calcium challenge during angioplasty. The specialist may use a medical drill mounted with industrial diamond and spin it at close to 200,000 rotation per minute to polish away some calcium inside the vessel wall (rotational atherectomy). This “thin out” and weaken the calcium deposit and allows the full expansion of balloons and stents to complete the angioplasty.
There is a new method to treat severe coronary calcification. Lithotripsy balloon is a recently introduced device that involves the use of Shockwave to break-up the vessel calcium. This is like how doctors use sonic wave to fracture the kidney stones. The lithotripsy balloon is introduced into the blocked artery and wedged within the narrowed segment while in close contact with the calcified plaques.
Multiple pulses of shockwave are then delivered to break-up the calcium deposit. The success of the shockwave therapy is confirmed by intravascular imaging and the remaining procedure involving stents placement can be completed uneventfully.
In the most severe disease, the senior doctor may combine both the coronary drill (rotational atherectomy) and the shockwave balloon to achieve optimal result.