Bill Klaproth: Heart disease is a common condition in the United States and the leading cause of death in this country. Now, patients with a certain type of coronary artery disease are being helped through innovative technology being used at Tidelands Health, such as sonic pressure waves, helping people with heart disease.

So let's learn more about sonic pressure waves with Dr. Victor Diaz, an interventional cardiologist at Tidelands Health. Dr. Diaz, thank you so much for your time. I really appreciate this. Before we talk about the new technology, sonic pressure waves, let's talk about the condition it treats. Can you tell us about coronary artery disease and how does that affect a person's health?

Dr. Victor Diaz: Heart disease is the number one killer in the nation. It is a very prevalent condition caused by the development of atherosclerotic plaque in the arteries supplying blood supply to the heart muscle. Frequently results in the need of revascularization therapies, which include percutaneous revascularization therapies or the possibility of coronary artery bypass graft surgery.

Bill Klaproth: Okay, got it. You called it the number one killer. So I would imagine this is a pretty common condition. Is that right?

Dr. Victor Diaz: Absolutely.

Bill Klaproth: So with coronary artery disease so prevalent, this innovative new technology of sonic pressure waves I'm sure is very welcome. So, what is this new technology and how does it work?

Dr. Victor Diaz: Sonic wave technology is technology that is aimed at fragmenting the calcium and the plaque causing the blockage in the coronary artery. The way it works is basically the same way that lithotripsy works for kidney stones. You have an emitter of ultrasound waves, which is located in the shaft of the balloon catheter that we bring into that coronary lesion and you inflate the balloon to low pressure atmospheres. And then through the emitter, you emit ultrasound waves that will then hit the plaque and the calcium on very high frequencies and crack up or fragment the calcium deposits and the plaque.

Bill Klaproth: So you've mentioned these coronary lesions that are calcified. So if they're calcified, they're really hard. So these sound waves get in, they just kind of pummel them, boom, boom, boom. And that allows you to do what you do, right? So these are really meant for these coronary lesions that have become calcified.

Dr. Victor Diaz: Heavily calcified lesions are a challenge for interventional cardiology, because they are very difficult plaques to treat, many times resulting in unsuccessful procedures percutaneously by either not being able to dilate the lesion because of the extensive amount of calcium or resulting in significant complications, such as dissection of the plaque or inability to fully deploy the coronary stent because of the calcium deposit and the plaque. And I would say that about 20% to 30% of the coronary lesions that we see are fairly heavily calcified and probably are higher risk lesions to treat with just a balloon and a stent on its own.

So the way this technology works is you bring the balloon catheter, which has the ultrasound-emitting components in the shaft of the balloon and you put it to where that blockage is and you inflate the balloon to low pressure, and then you provide treatment with the ultrasound waves to shake the calcium and the plaque and break it off or fragment it. That will then allow you to fully expand a balloon to completely open up the blockage and then be able to bring in what is the ultimate treatment, which is the stent, the coronary stent, the metal stent, to fully deploy it to the maximum diameter of that vessel so it matches one-to-one the size of the stent versus the size of the reference vessel and it's fully expanded.

Bill Klaproth: Right. And then ultimately, this results in a better patient outcome, right? That's what this technology does.

Dr. Victor Diaz: Yes. So, like I said earlier, heavily calcified lesions are a frequent situation where you have unsuccessful percutaneous revascularization due to either inability to fully dilate the lesion or serious complications, those chest dissections. This technology provides the ability to fully dilate the balloon and the stent and with a lower risk of dissections. So it provides a higher risk of successful percutaneous coronary intervention.

Bill Klaproth: So before this technology, what did you do to try to overcome these calcified lesions?

Dr. Victor Diaz: So other technologies available prior to this, first of all, there was just balloon with or without a stent. And like I said earlier, in heavily calcified lesions, just ballooning it alone many times results in inability to fully dilate the lesion.

Other technologies that are geared towards treatment of calcified lesions is rotational atherectomy. That is a technology, which is probably better described as a miniaturized diamond-tipped drill. You kind of drill through the blockage. And it is an appropriate technique to treat heavily calcified lesions. It is a much more cumbersome and time-consuming technique. And it creates a little bit of anxiety on operator and staff, and it takes a lot longer than the shockwave technique. The other limitation with it is that you're only creating a lumen that's as large as the burr size of the Rotablator. And the burr size is as small as 1.5 millimeters and the larger burr size is 2.25 millimeters. So you are really not going to be able to create a channel that's much bigger than 2.25 millimeters without the need of further ballooning and/or stenting with rotational atherectomy. So it does provide the ability to remove some calcium that is in the internal endothelial surface of the artery, but it doesn't provide you to treat deep calcium; whereas shockwave travels the whole depth of the coronary plaque, and it treats not only the superficial endothelial calcium, but it treats deeper calcium into the mid or more epicardial edge of the plaque.

Bill Klaproth: So what kind of results have you seen in patients so far then?

Dr. Victor Diaz: I've had excellent results and all cases have I been able to fully dilate the vessel and expand the stent without any complications? It's very user-friendly. And the results are extremely good with it.

Bill Klaproth: Wow. This is amazing. You said earlier this is really best for heavily calcified lesions. That is plaque buildup that is really hardened. Is that what you mean when you say that?

Dr. Victor Diaz: Exactly. There are some plaque buildups that don't have a lot of calcium. There consists of soft, mostly cholesterol blockage, and those are easy to just balloon with a regular balloon and a stent. But these heavily calcified lesions provide an extremely hard challenge for interventionalists in being able to successfully treat it through catheter technologies. And this is one more tool that we have on these very difficult lesions to be able to come out with a successful procedure.

Bill Klaproth: This is a really great technology. We're so happy that Tidelands has it and that you're finding great success with it so far. Dr. Diaz, thank you so much for your time. Anything else you want to add about coronary artery disease or the new sonic pressure waves technology?

Dr. Victor Diaz: I would like to add that coronary disease is a very prevalent condition. Risk factors for coronary disease include hypertension, hyperlipidemia, diabetes, smoking, and stuff that is very prevalent in our society. And modifying those risk factors helps prevent the development of disease. But if you are having symptoms of chest pain or shortness of breath, you should seek medical help and be checked by your doctor and/or your cardiologist to see if you are at high risk of having a severe lesion that might need revascularization, be it through percutaneous catheter base means, or be it through bypass surgery.

Bill Klaproth: Well said, Dr. Diaz. As they say, prevention is the best form of medicine. So thank you so much for your time and talking to us about sonic pressure waves. So great to hear this being utilized at Tidelands Health. Thank you again. This has really been informative.

Dr. Victor Diaz: Thank you.

Bill Klaproth: And once again, that's Dr. Victor Diaz. And for more information, call 1-866-TIDELANDS or go to tidelandshealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Better Health Podcast. I'm Bill Klaproth. Thanks for listening.