CHIP Technology
CHIP Technology: Complex Coronary Artery Disease
Complex coronary artery disease (CAD) management may not be feasible nor optimal with standard angioplasty techniques alone. Here are some of the latest technologies used in CVSKL to treat the complexity of coronary heart disease.
Coronary artery disease drug-eluting stents
Stent utilized in CVSKL are clinically proven in many medical studies and are approved devices by major regulatory bodies (for example US FDA, and the European Medicine Agency)
Specialised stent platforms available include:
- A stent that is designed with high strength to scaffold large arteries, with more than 4.00mm vessel size.
- A stent that can restore vessel pulsatility and potentially improve vessel remodelling and plaque stabilisation.
- Resorbable magnesium scaffold where 95% of the stent material will be resorbed in 12 months.
Photos: There are a variety of stent platforms to accommodate your coronary vessel.
Balloon angioplasty
Balloon angioplasty is used to prepare a lesion before stent placement and to optimise the stenting results. In some cases, medicine-coated balloons are used as the final treatment for the disease.
Some of our featured balloons:
- Cutting and scoring balloons to treat resistant and calcified lesions
- High-pressure and ultra-high-pressure balloons for highly calcified, resistant, and under-expanded stent lesions
- Drug-coated balloon designed to treat restenosis and small vessel disease.
Invasive Coronary Imaging
Modern coronary angioplasty with adjunctive use of intravascular imaging-guided treatment and improves results and patient outcomes. The modalities available in CVSKL include:
- High-definition intravascular Ultrasound (HD-IVUS)
- Optical coherence tomography (OCT)
Coronary Physiology Assessment
Measurement of flow and flow-derived parameters in the coronary artery has been proven to guide decision-making for angioplasty and to assess the adequacy of treatment.
Physicians can target treatment only to the flow-limiting heart blockages that are important to improve patient’s symptoms and outcomes. This assessment may be performed via two available modalities:
- Fractional Flow Reserve (FFR): Invasive coronary pressure wire and sensor to measure flow in the arteries during the catheterization procedure, and using Adenosine (pharmacology agent) to assess the flow.
- Quantitative Flow Ratio (QFR): Non-invasive functional assessment of coronary narrowing derived from the coronary angiographic images.
- Murray Law-Based QFR (μQFR): A latest advanced imaging technology that uses coronary angiographic images to determine whether a narrowing in the heart artery is affecting blood flow, helping support more accurate treatment decisions.
Coronary Calcium Modification Technologies
The presence of significant coronary artery calcification complicates the angioplasty procedure. It may hinder stent delivery, and stent expansion, and lead to a higher chance of complications. The calcium component of the plaque needs to be modified to facilitate the angioplasty procedure, reduce complications, and improve long-term outcomes.
The technologies available to modify coronary calcium in CVSKL include:
- Ultra-high-pressure balloons (e.g., OPN balloon)
- Rotational Atherectomy (Rotablator)
- Orbital Atherectomy (OAS)
- Intravascular lithotripsy (Shockwave)
- Intravascular lithotripsy (Balloon)
LithiX HC-IVL: Advancing the Treatment of Calcified Coronary Artery Disease
Coronary artery disease becomes increasingly challenging when significant calcium deposits develop within the blood vessels. Calcified lesions can make routine angioplasty and stent implantation more difficult by preventing optimal stent expansion and increasing procedural complexity. Adequate calcium modification is therefore essential to achieve better procedural and long-term clinical outcomes.
As the first hospital in Asia to introduce this groundbreaking innovation, LithiX Hertz Contact Intravascular Lithotripsy (HC-IVL) marks a significant advancement in the treatment of moderate to severely calcified coronary artery disease. This next-generation technology utilizes a novel calcium modification mechanism designed to fracture calcified plaque within the arterial wall while minimizing trauma to surrounding healthy tissue. Unlike conventional energy-based lithotripsy systems, LithiX eliminates the need for an external generator or energy source, offering a simplified workflow and improving procedural efficiency.
How LithiX HC-IVL Works
LithiX uses the Hertz Contact Stress principle, incorporating specialized metallic hemispheres embedded within a balloon catheter. During balloon inflation, focal pressure amplification creates controlled micro-fractures within calcified plaques, improving vessel compliance and facilitating better lesion preparation before stent deployment.
This approach allows effective modification of both superficial and deeper calcium layers, creating more favorable conditions for optimal stent expansion and apposition.
Key advantages of LithiX HC-IVL
- Simplified workflow – The system does not require external generators, cables, or additional capital equipment, simplifying procedural setup and potentially reducing procedure time.
- Effective calcium modification – Clinical studies have demonstrated successful calcium fracture across various lesion morphologies, supporting improved vessel preparation and stent expansion.
- Favorable safety profile – Early clinical experience has shown high procedural success rates with low rates of major adverse cardiac events.
- Emerging Clinical Evidence -Real-world clinical experience has shown favourable results, including excellent stent expansion and low complication rates across diverse calcified lesion patterns.
A New Era in Calcium Management
The evolution of calcium modification technologies continues to improve the treatment of complex coronary artery disease. LithiX HC-IVL provides interventional cardiologists with an innovative option that combines procedural simplicity with effective calcium fracture and promising clinical outcomes.
As experience and evidence continue to grow, this technology may further enhance treatment strategies for patients with complex calcified coronary lesions, helping achieve safer procedures and better long-term results.
Mechanical Circulatory Support (MCS)
Performance of complex angioplasty especially in a patient with a poor heart function is highly risky with the possibility of cardiac arrest during the procedure. For this reason, Mechanical Circulatory Support (MCS) devices can be used to support heart function.
There are two types of MCS devices used in CVSKL:
- Intra-aortic balloon pump (IABP) – which provides heart function support.
- Impella® device – which is one of the technologies available today for optimal support during high-risk angioplasty procedures.
With these technologies, some of the most high-risk patients who are unfit to undergo surgical treatment may be offered mechanical circulatory-supported angioplasty treatment options and a complete revascularization could also be performed.
Related videos
Throughout the broadcast, our doctors shared their extensive knowledge and experience to the participants in Bangladesh. The procedure was successfully executed, showcasing the utilisation of an advanced imaging technique called Optical Coherence Tomography (OCT) Imaging. This innovative approach optimises the management and long-term outcomes of complex percutaneous coronary interventions.
Here in CVSKL, we take pride in our role as advocates for ongoing learning, ensuring that the latest advancements and knowledge in cardiovascular care are shared and accessible to healthcare professionals around the world.