There is a consensus in the field of coronary interventions: fear not the earth, but fear calcification in the coronary arteries! Severe coronary artery calcification is like a blood vessel full of "stones", and the blood does not pass smoothly, which can easily lead to myocardial ischemia and even myocardial infarction. Recently, the Department of Cardiovascular Medicine of Southwest Hospital of the Army Medical University successfully performed the first case of "Intravascular lithotripsy (IVL)" in the western region using innovative domestic devices, and became one of the first centers in China to perform this technique. The center is one of the first in China to perform this technique.
The patient, Mr. Liu (pseudonym), was 76 years old and recently had frequent chest pains. The examination revealed that the right coronary artery was severely stenosed and calcified, and the hardness of the calcified plaque was similar to the hardness of bone, making it difficult to implant the stent smoothly. Due to the old age and underlying diseases, if the blood vessel is not opened as soon as possible to improve blood flow, it may lead to more serious consequences at any time.
What is a severely calcified coronary lesion?
Severe coronary artery calcification is a high-resistance complex lesion with an increasing incidence in recent years. It is a difficult and risky procedure with a high incidence of serious intraoperative complications such as "vessel entrapment, perforation, rupture, and no recurrent flow" and postoperative complications such as "intra-stent thrombosis and restenosis", which are difficult and painful points in the field of coronary intervention.
Through active communication with the family and the patient, Assistant Director Zhu Ping, Associate Professor Qu Xiaolong, and Attending Physician Liu Feng of the Coronary Intervention Team at the Department of Cardiovascular Medicine, Southwest Hospital, Army Medical University, led by Director Zhang Zhihui, tailored a plan to optimize the procedure using IVL, a new clinical technology.
IVL is a new and improved application of traditional technology, which has been approved for marketing in more than 60 countries and regions worldwide, and its imported SHOCKWAVE system was approved for marketing in China in May 2022, but it is currently more expensive. This technology is to achieve the effect of calcified plaque modification by shaking loose the calcified deposits in the vessel wall through acoustic pressure wave, which only acts on the high-density tissues such as calcified lesions and does not affect the normal soft tissues and does not destroy the elastic layer within the endothelium, which can maintain the integrity of the endothelium. Compared with traditional techniques, it has greatly improved in safety and operability. At present, only a few hospitals in China carry out IVL treatment with the imported SHOCKWAVE system adapted to it.
"It is worth noting in particular that the pulsed acoustic balloon system we used this time is an innovative device independently developed domestically." Zhang Zhihui, director of the Department of Cardiovascular Medicine, introduced. The domestic pulsed acoustic wave balloon system used for the operation of patient Master Liu is an innovative device independently developed by domestic enterprises, led by Prof. Tang Yida and Prof. Cui Ming of the Third Hospital of Peking University, which organized 14 large hospitals nationwide to carry out prospective, multicenter premarket clinical studies, and Southwest Hospital of Army Military Medical University was the only participating research center selected in the western region.
During the surgery, the team first accurately assessed the target lesion through intracoronary optical coherence tomography and formulated the optimal surgical strategy, then used a domestic pulsed acoustic balloon system to adequately pre-treat the target lesion, "shatter" the 360° calcified ring covering the vessel wall, and then opened the "channel" through balloon expansion, and finally successfully implemented the stent implantation.
The clinical research team of the Department of Cardiovascular Medicine, under the guidance of the hospital's Clinical Trial Organization Office, strictly followed the GCP experimental procedures and specifications to complete the relevant procedures and carry out the surgery, and successfully achieved the first patient enrollment of a domestic innovative device, which not only brought tangible clinical benefits to patients and saved treatment costs, but also introduced cutting-edge new clinical treatment technologies to the hospital, and made a western contribution to the development and application of domestic innovative devices for the benefit of patients with cardiovascular diseases.
Introduction to Cardiovascular Medicine
The Department of Cardiovascular Medicine was established in 1980 (Cardiac and Renal Medicine), and was independently operated in 1992. In 2007, the Department of Cardiovascular Medicine was awarded as a national key discipline, a training base for interventional techniques for cardiovascular diseases (coronary heart disease, arrhythmia and precordial disease) by the Ministry of Health, and an interventional center for the military.
Now it is the discipline that confers medical doctorate, postdoctoral mobile workstation, national clinical pharmacology base, demonstration base of Chinese atrial fibrillation center, national standardized atrial fibrillation center of excellence, Chinese chest pain center, national standardized chest pain center of excellence, Chinese cardiogenic stroke prevention and treatment base, Chinese cardiac rehabilitation center construction unit and Chongqing Institute of Interventional Cardiology. The biennial Southwest Great Wall Cardiovascular Conference is a national high-impact academic conference, which has become a bright academic card of the department.