KRH Cardiologists Perform Hospital's First Intravascular Lithotripsy

Hall and Agrawal

For patients who suffer from peripheral artery disease, there is now a new alternative procedure that was conducted by Rocky Mountain Heart & Lung cardiologists recently that may address some of the risks that come with traditional techniques. Back in July, Nathaniel Hall, MD and Mayank Agrawal, MD, performed the hospital’s first intravascular lithotripsy, a procedure that abrades atherosclerosis (plaque buildup) within a peripheral artery using a shockwave balloon (Source: Shockwave Medical, Inc.).

There have traditionally been two procedures conducted at Kalispell Regional which address artery blockage in both peripheral and cardiac intervention: A balloon angioplasty and a rotational atherectomy.

Balloon Angioplasty: A catheter is inserted into the artery with a balloon on the tip of it. The balloon is then inflated at the blockage site to compress the plaque against the artery. A stent is then placed in that spot to keep the vessel open, allowing proper blood flow. The risks involved in a balloon angioplasty are over inflation which can cause the artery to burst.

Rotational Atherectomy: A catheter with a burr at the tip is inserted into the artery to break down the calcium buildup. This technique works better with the more calcified plaque, which is harder to break up. The downside to this tactic is that there is minimal flexibility as you are unable to go around sharp angles. There is also a risk of puncturing the artery in the process.

The new tactic uses sonic pressure waves inside of a balloon inflated to very low pressure that creates shockwaves large enough to break up the plaque buildup without rupturing or puncturing the artery. This tactic is relatively new to peripheral intervention and is thought to only be done at ne other hospital in Montana. While trials are still ongoing, doctors anticipate that this tactic will be available for cardiac intervention by 2021.

“Intravascular lithotripsy is an exciting therapy which will allow us to optimally treat lesions which would have previously been difficult to treat or where traditional methods would have produced a suboptimal result,” says Dr. Hall. “We look forward to using this technology to provide state of the art care for patients in the Flathead Valley and beyond.”