Daily Mail - 30.07.2019

Page 46 Daily Mail, Tuesday, July 30, 2019

ME & MY OPERATION

SHOCKWAVES FOR CLOGGED HEART ARTERY

WHAT ARE THE RISKS?

O A SMALL risk of heart

attack and stroke — around

one in 300, the same as for

any angioplasty procedure

(where a stent is inserted).

O THERE is a theoretical risk

that the sonic waves are not

able to shatter the calcium

deposits, however patients

are carefully selected and

only suitable cases treated.

O ‘THIS procedure carries no

more risk than having a stent

put in place, and less risk than

the alternative, which uses a

drill,’ say Dr Joe Mills, a

consultant cardiologist at the

Liverpool Heart and Chest

Hospital. ‘It is straightforward

and it is likely this technique

will become more important

over time.’

SURGERY for narrowed arteries

traditionally involves opening

them up with a tiny balloon —

but now, shockwaves can blast

through blockages first. Farhad

Mir-Shekari, 70, a retired

software engineer from

Kettering, tells CAROL DAVIS

about having the procedure.

But, even so, every few years I

had another angina attack. In

July and August last year, they

became more frequent again —

every couple of weeks.

My GP referred me to Kettering

General Hospital, where I saw

cardiologist Dr Prashanth Raju.

I had more tests, which showed

my other coronary artery was

becoming narrowed, and this

blockage was in a bend in the

artery where it was harder to

insert a stent.

Dr Raju said they could use a

specialist drill to crack through

the calcified deposits, but said

this carried risks, including

puncturing the artery. If it didn’t

work, it would mean open-heart

surgery, with a long recovery.

H

E THEN told me he

was using a new tech-

nique with a balloon

and an electric charge,

which would ‘shake’ at ultra-

sonic speed to crack the

calcium — they could then

push it back against the artery

wall and insert a stent to keep

the artery open. Rather like a

smashed car windscreen, the

calcium would crack and shat-

ter but stay in place, pushed

back against the artery walls.

I’d be only his third patient to

have it, but he was so confident

about the approach that I felt

happy, too. I had the 30-minute

procedure just before Christ-

mas under local anaesthetic

and light sedation.

Dr Raju put a needle into an

artery in my wrist and threaded

through it a catheter containing

the calcium-cracking balloon,

which went through my body to

the blocked heart artery.

As he’d warned, I felt breath-

less and had bad chest pain,

like a mini heart attack, during

the procedure, but I knew it

would pass. I didn’t even feel

the sonic pulses.

My son Rad, 38, and wife Angel,

62, took me home that evening.

I took it easy for a couple of

weeks and am still on some

medication to increase my

heart’s efficiency.

But now, I’m far less breath-

less and have had no more

angina attacks — it’s wonder-

ful. I can walk more and help

our elderly dog into the car.

THE SPECIALIST

Dr Prashanth raju is

an intervention cardiology

consultant at Kettering

General hospital.

AlMosT everyone over 60 has

some degree of coronary artery

disease — where the arteries

supplying blood to the heart

become covered in fatty plaques

that calcify, which makes them

inelastic and can block them.

This can lead to a heart attack.

High blood pressure, smoking,

age and uncontrolled diabetes

increase the risk, and numbers

are rising as people live longer.

Angina is the pain that occurs

as a result of having this plaque

— it is not harmful in itself, but

does put a person at higher risk

of a heart attack.

Decades ago, the main inter-

vention was a coronary artery

bypass, in which blood is

diverted around the blockage

through a healthy blood vessel

taken from the leg, arm or

chest. This major operation

involved sawing through the

breastbone and had a recovery

of up to six months.

But now, we have many more

options, including stents, which

are basically a scaffold to keep

an artery open and are often

coated with drugs to prevent

calcification building up again.

We put them in place via the

wrist, expanding a balloon in

the narrowed artery to push

back the calcification and keep

the artery open with the stent.

But, in around 10 per cent of

cases, the calcification is too

severe, so there is just a tiny

hole in the plaque — and, when

we try to expand the balloon,

it takes on the shape of a dog’s

bone and won’t expand. We can

try using a catheter with a blade

at its tip, or rotablation, which

uses a tiny drill to work through

the build-up.

But this carries the risk of

damaging the artery, or of small

fragments of calcium breaking

off and causing a blockage.

lithotripsy, involving shock-

waves, has been used for decades

to break up hard kidney stones.

However, its use in cardiology is

very new and exciting — it has

been around for only a few years,

but already, 3,000 patients have

been treated in Europe.

Instead of a drill, we use a

balloon that emits electrical

pulses — these create sonic

pressure waves, which pulse

and create tiny cracks in the

calcium, without affecting the

surrounding tissues.

once the hard calcium is in

pieces, we can expand a balloon

inside to push back the calcium

against the blood vessel walls

and then keep the artery open

using a traditional stent.

This is exciting, as it has fewer

potential complications than

rotablation and the patient

need not stay in overnight.

The procedure takes around

30 minutes under local anaes-

thetic and light sedation — and

cracking the calcium takes only

a couple of minutes.

I put a needle into the wrist

artery and, guided by X-ray,

slide a catheter or tube up to

the heart artery. I slide the shock-

wave balloon through this tube

to reach the narrowed section.

The balloon and catheter are

connected to a machine that

generates the sonic waves and

is controlled by a button rapidly

pulsing ten times to crack the

calcium — we can repeat this

if necessary.

I then slide a second balloon

up to press the cracked calcium

against the artery wall and

expand a stent in place using a

balloon to keep the artery open

permanently. Most patients go

home the same day.

O the operation costs the

nhs £4,000 — it is not

available privately.

a heart attack. This happened every
couple of weeks.
on one such occasion, in April
2007, when I was 57, I did have a
heart attack on the A&E ward. It
was terrifying, but I was lucky to
be close to great care. Tests showed

one of my two coronary arteries

that supply the heart muscle was

partly blocked by calcified plaques,

and my heart muscle was damaged

as a result.

I stayed in hospital for five days

before they transferred me to

leicester Royal Infirmary, where

they put in a stent [small tube] to

widen the artery and keep it open.

That was amazing: suddenly, after

so long, I could breathe properly.

THE PATIENT

S

oME 15 to 20 years ago, I
began having repeated
angina attacks — crushing
pain in the centre of my chest
— which doctors said were
caused by narrowed arteries reduc-

ing blood flow to my heart.
I had always tried to live a healthy
lifestyle, walking the dog and avoiding
fatty foods, but the pain was worrying
and I was also increasingly breathless.
I was prescribed bisoprolol medication,
to lower my blood pressure and make my
heart work more efficiently, but I was still
breathless, as my narrowed arteries were
making it harder for oxygenated blood to
flow around my body.
sometimes, it was hard to breathe even
when watching TV. It got to the stage
where I could barely do anything.
Whenever I had a particularly severe
attack of angina, I’d call an ambulance and
be blue-lighted to A&E, just in case it was

SONIC BLASTER

Unblock arteries

and get home

faster with a new

96,000

Number of new cases

of angina diagnosed

in the UK every year

Picture:

ALAMY