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New technology helps patients with coronary disease avoid surgery

September 12, 2022 Heart Health

For most people with coronary atherosclerosis—the narrowing of heart arteries due to plaque buildup—treatment is fairly straightforward. Cardiologists can restore blood flow to the heart with the help of a stent, relieving symptoms like chest pain and helping to prevent heart attacks. But for those with advanced coronary artery disease (CAD) whose plaque has hardened to a point that a stent cannot be easily placed, the condition is much more complex. Now, new technology called Shockwave therapy is available to effectively treat these patients with a lower risk of complications.

"Before Shockwave therapy, we performed an atherectomy to break up hardened plaque in the artery before placing a stent. This involved the use of a tiny spinning drill guided to the point of the blockage," explains Sarang Mangalmurti, MD, interventional cardiologist at Bryn Mawr Hospital, part of Main Line Health. "However, atherectomy carries a risk of emergency bypass surgery if the shaved plaque dislodges and closes off the artery. Shockwave therapy reduces the risk of invasive treatment."

Cutting-edge therapy

Bryn Mawr Hospital was one of a handful of sites nationwide involved in a clinical trial to test the safety and effectiveness of Shockwave therapy. It was also among the first in the U.S. to provide this cutting-edge treatment. The therapy uses ultrasonic waves to break down hardened plaque.

"Shockwave therapy works similarly to how kidney stones are broken down," says Dr. Mangalmurti. "Instead of applying ultrasonic waves from the outside of the body, a small balloon is guided through the artery to the blockage where special electrodes emit these waves. The waves cause microfractures in the plaque which allow us to channel through and open the artery with a stent."

Since beginning the trial, Main Line Health has continued treating patients with this advanced therapy and is now helping train other cardiologists on how to use it.

"Our involvement in the clinical trial not only paved the way for the therapy's approval in March 2022, but provided our patients access to the treatment earlier," says Dr. Mangalmurti. "Compared to traditional treatment, fewer people need surgery for coronary artery disease with Shockwave therapy."

Safer care for women

The approval of Shockwave therapy is especially beneficial to women who are more likely to be diagnosed with CAD at later stages when it's more difficult to treat.

"Through prior clinical trials, we learned that atherectomy can be more dangerous for women than men. Women are at higher risk of bypass surgery because their coronary vessels are smaller and more challenging to treat," explains Dr. Mangalmurti. "This study showed that Shockwave therapy was equally safe and effective for women and men."

Comprehensive heart program

Shockwave therapy is just one example of Main Line Health's dedication to providing cardiovascular patients access to the most innovative and least invasive treatments available. Bryn Mawr Hospital and Paoli Hospital welcomed new, state-of-the-art interventional labs, offering the most advanced diagnostics and treatment available for patients experiencing stroke and heart disease. These allow cardiovascular and neurointerventional teams to perform even more complex procedures as well as serve a greater number of patients.

"Main Line Health is truly a leader in cardiovascular health," says Dr. Mangalmurti. "We offer everything an academic institution does without the need to travel away from home."

Watch how Main Line Health is transforming cardiac care