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![INTRODUCTION
• Coronary artery calcium- independent
predictor of worse prognosis
TRIALS f/u Outcome
Bourantas et al, 2014 BMJ 3 yr • High mortality
(10.8 vs 4.4) [p <0.01]
• Lower rates of
complete
revascularization
HORIZONS-AMI 1 yr Rates of complications
Stent underexpansion
ACUITY CORONARY
CALCIUM](https://image.slidesharecdn.com/ivlbasics-220222135523/75/Ivl-basics-3-2048.jpg)
![LITHOTRIPSY [Litho-stone; tripsy-break]
• 30 yrs safety data in kidney stone treatment](https://image.slidesharecdn.com/ivlbasics-220222135523/75/Ivl-basics-8-2048.jpg)
![• Inflate balloon @ 4 atm with saline
contrast[60:40] & deliver treatment sequence
(1 cycle-10 pulses over 10 sec) {Total- 80 pulses}
• Inflate the balloon upto 6 atm till cool down
phase
• Repeat as necessary, deflating the balloon
between treatments to re establish flow](https://image.slidesharecdn.com/ivlbasics-220222135523/75/Ivl-basics-18-2048.jpg)
![EFFECT ON CARDIAC RHTYHM
• Acoustic shock waves
• Localised myocardial depolarization
• APCs or VPCs (Shocktopics)
[No VT induced by IVL has been so far reported]](https://image.slidesharecdn.com/ivlbasics-220222135523/75/Ivl-basics-31-2048.jpg)
More Related Content
Ivl basics
- 1. CORONARY INTRAVASCULAR LITHOTRIPSY -ROHIT WALSE FELLOW INTERVENTIONALCARDIOLOGY SCTIMST, KERALA
- 2. SCOPE • INTRODUCTION • LIMITATIONOF CURRENT ATHERECTOMY • LITHOTRIPSY-MECHA, HARDWARE, STEPS • DATA
- 3. INTRODUCTION • Coronary arterycalcium- independent predictor of worse prognosis TRIALS f/u Outcome Bourantas et al, 2014 BMJ 3 yr • High mortality (10.8 vs 4.4) [p <0.01] • Lower rates of complete revascularization HORIZONS-AMI 1 yr Rates of complications Stent underexpansion ACUITY CORONARY CALCIUM
- 4. Heavily calcified vesselby OCT • Arc >1800 • Length > 5 mm • Thickness > 0.5 mm
- 5. Predictable problem duringvessel preparation • High pressure balloon dilatation • Constant High pressure • Violates intima of vessel • Inflammation, Smooth muscle proliferation • Scar • Less effective Intervention
- 6. Limitation of currentatherectomy • Selectively ablates superficial calcium • Incomplete or asymmetric stent expansion acute or subacute stent failure
- 8. LITHOTRIPSY [Litho-stone; tripsy-break] •30 yrs safety data in kidney stone treatment
- 9. MECHANISM • Impact hardtissue • Disrupts calcium • Soft tissue • No harm • Sonic pressure waves
- 10. IVL TECHNOLOGY • Miniaturized& arrayed lithotripsy emitters for localised lithotripsy at the site of vascular calcium • Optimized for treatment of vascular calcium
- 11.
- 17. Steps of use •Identify the lesion & predilate as necessary • Select IVL balloon catheter size- 1:1 • Load the catheter, position the balloon within target lesion
- 18. • Inflate balloon@ 4 atm with saline contrast[60:40] & deliver treatment sequence (1 cycle-10 pulses over 10 sec) {Total- 80 pulses} • Inflate the balloon upto 6 atm till cool down phase • Repeat as necessary, deflating the balloon between treatments to re establish flow
- 24. PRACTICAL POINTS • Concentriclesions- 2-3 cycles • Eccentric lesions- 3-4 cycles • Long lesion- Distal to proximal • Calcific spikes- 1-2 cycles (upto 4 atm) n then during 3-4th cycle upto 6 atm
- 29. Advantages of IVLin LM ds • Safely Modifies Calcium with Low Risk of Perforation • Ability to Have Buddy Wire in Place While Modifying Calcium • Can Modify Calcium in Large Vessels Not Ideal for Rotational Atherectomy (RA) • Ability to Impact Deeper, Medial Calcium
- 30. Advantages in bifurcationlesion • Ability to Navigate Tortuous Anatomy • Can Keep Multiple Wires Down While Modifying Calcium • Circumferential Calcium Modification Without Wire Bias • Low Risk of Dissection
- 31. EFFECT ON CARDIACRHTYHM • Acoustic shock waves • Localised myocardial depolarization • APCs or VPCs (Shocktopics) [No VT induced by IVL has been so far reported]
- 38.