Vascular Calcification and Treatment Solutions
Vascular calcification (VC) is a complex intracellular molecular process. It refers to the formation of calcified deposits of hydroxyapatite crystals within the vessel tissues. Depending on the vessel affected, VC can be categorized into coronary artery calcification (CAC), peripheral vascular calcification (PVC), and heart valve calcification. People with metabolic syndrome, dyslipidemia, tobacco use, hypertension, chronic kidney disease, and a high baseline C-reactive protein level are at an increased risk to develop VC. It has been further evidenced that the Chinese population seems to be more prone to develop VC as compared to people from many other countries, which might relate to certain demographic factors such as dietary habits, genetic predisposition and common osteoblast phenotype.
The presence of VC is not only often associated with major adverse cardiovascular events, but also makes open surgeries and PCI procedures more challenging. VC increases the likelihood of procedural failure, as well as post-procedure complications (e.g., vessel closure and dissection). In recent years, modified versions of PTA balloons such as scoring balloons and cutting balloons were developed, which improve vessel compliance by creating discrete incisions in the atherosclerotic plaque, enabling greater lesion expansion and reducing recoil while preventing uncontrolled dissections. However, for patients with severe calcification, scoring balloons, cutting balloons and high-pressure balloons might also not be able to reliably dilate vessels containing rigid calcium plaques. Therefore, when treating patients with severe calcification, physicians typically need to pre-treat the vessels to remove the calcified plaques.
Currently, there is no golden standard for the treatment of VC, and promising treatment methods used to remove calcified plaques primarily include atherectomy (using rotational, orbital, or laser atherectomy devices), as well as intravascular lithotripsy (IVL) (using IVL devices such as impulse balloon catheters).
Impulse Balloon Catheter Intravascular Lithotripsy
(Impulse Balloon Catheter IVL)
Impulse balloon catheter IVL uses sound pressure waves to destroy calcium with minimal impact on soft tissues. Energy is delivered through the balloon catheter, and is then transmitted to the wall of the balloon, which is inflated at low pressure, to achieve sufficient diameter to contact the vessel wall. The shock energy reaches the calcified segment of the vascular tissue and breaks such calcified parts.
Impulse balloon catheter IVL has several advantages to treat VC as compared to other treatment methods, including:
• Safe. By relying on locally delivered sonic pressure, impulse balloon catheter IVL can safely modify both intimal and medial calcium without causing perforations, distal embolization or damage to the vasculature and surrounding tissues.
• Effective. Impulse balloon catheter IVL create shockwaves that penetrate through the entire depth of the vessel wall, modifying calcium in the intimal and medial layers of the vessel.
• Easy to use. Physicians use impulse balloon catheter IVL essentially in the same way as they use standard angioplasty catheters, so it involves lower learning curve, shorter physician training time, and can reduce the possibility of human error during the procedures. After the calcium plaques are removed, physicians maintain the ability to use other interventional tools of their choice.