New treatment in Malaysia for atherosclerosis uses sonic waves

Dr Amin (second from right) holding up the IVL equipment, with the team of cardiologists, nurses and one technician who helped with the procedure. — IJN

A procedure known as intravascular lithotripsy (IVL) was successfully performed for the first time in Malaysia at the National Heart Institute (better known by its Bahasa Malaysia acronym IJN) on Feb 22 (2021).

Approved by the US Food and Drug Administration (FDA), this method uses sonic waves to treat heart patients suffering from severe atherosclerosis.

Atherosclerosis is a condition where cholesterol, fats and calcium deposits form plaques in the arteries.

The accumulation of these plaques causes narrowing of the arteries and limits blood flow to the organs.

When discovered early, atherosclerosis can be treated with lifestyle changes and medication to slow down, or even reverse the build-up of plaque.

More advanced blockages are commonly treated with angioplasty and stent placement.

This involves using a small balloon attached to a catheter, which is delivered to the site of the blockage through the patient’s blood vessels.

The balloon is then inflated to expand the artery passage and squeeze the plaque aside.

A stent is then placed to keep the artery open for good blood flow.

However, angioplasty may not be useful in severe cases where the plaque has hardened and become calcified.

IJN senior consultant cardiologist Datuk Dr Amin Ariff Nuruddin explains: “When the plaque has hardened to that extent, patients may have to undergo an invasive surgical procedure to treat the condition, where doctors have to surgically remove the plaque, or even perform a graft bypass to ensure good blood flow.

“In this regard, IVL offers us a minimally-invasive treatment option that lessens the risks of surgery for these patients.”

Similar to angioplasty, IVL utilises a catheter with a balloon attached.

The difference is that the balloon generates sonic pressure waves to break the plaque, instead of physically squeezing it to the side, which may not be possible when it is calcified and hard.

This allows the artery passage to be expanded and optimises the use of stents to keep the passage open at the affected area.

Dr Amin adds that aside from the ease of use of the device, it also reduces trauma to the tissue, as it selectively pinpoints the blockage.

“This in turn minimises the risk of the patient developing other complications following the procedure, as compared to the other current debulking devices presently available,” he says.