Shockwave-facilitated Aortoiliac Treatment with Impella

September 23, 2019

A “Transformative Technique”

Dr. Jason Wollmuth describes how Shockwave lithoplasty may provide a safer way to gain large bore femoral access by minimizing vessel trauma/dissection and limiting the need for stenting. He presents a complex case in which Shockwave facilitated Impella CP® support as well as multivessel PCI.

The Shockwave Medical Intravascular Lithotripsy (IVL) System, explains Dr. Wollmuth, is able to modify plaque in a way that traditional balloon angioplasty is not able to do. The Shockwave balloon is inflated at very low pressures and emits soundwaves to shatter calcium in vessel walls. "I had done a handful of cases with Shockwave in the SFA,” notes Dr. Wollmuth. “I'd never used one in an iliac artery until this case. But if you can blow up a balloon, you can use Shockwave. It's as simple as inflating the balloon and pushing a button to deliver the pulses.”

Dr. Wollmuth presents the case of a 69-year-old male with a long history of peripheral vascular disease, prior circumflex stent placement, and significant risk factors, including chronic kidney disease. The patient had multivessel disease requiring PCI with hemodynamic support; however bilateral iliac disease, left iliac aneurysm, and limited axillary options presented vascular access challenges for Impella. Other challenges in this case included limited pre-procedure imaging due to the need to minimize contrast use, potential need for a second access to address CTO, and renal insufficiency.

Dr. Wollmuth describes how he used Shockwave to treat the iliac system to facilitate Impella long-sheath delivery and subsequent treatment, including stenting and atherectomy. “I think this is going to change my practice,” he notes. He explains that he had switched to doing a lot of percutaneous axillary cases for Impella in patients who had aortoiliac disease, but this experience with Shockwave has changed his thinking. “We can use it quickly and safely and get on with our coronary work that we need to do.”

Dr. Wollmuth believes that Shockwave is “a transformative technology for delivering Impella sheaths through the femoral artery."

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