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ME & MY OPERATION: Unblock arteries and get home faster with a new sonic blaster

THE PATIENT

Some 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 reducing 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.

Under the knife: Farhad Mir-Shekari, 70, a retired software engineer from Kettering, began having repeated angina attacks two decades ago – which is when his problems began

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 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. 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.

He then told me he was using a new technique with a balloon and an electric charge, which would ‘shake’ at ultrasonic 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 shatter 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 Christmas 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.

'Now, I’m far less breathless and have had no more angina attacks — it’s wonderful. I can walk more and help our elderly dog into the car,' he says

‘Now, I’m far less breathless and have had no more angina attacks — it’s wonderful. I can walk more and help our elderly dog into the car,’ he says

As he’d warned, I felt breathless 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 breathless and have had no more angina attacks — it’s wonderful. 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 intervention 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 shockwaves, 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 anaesthetic 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 shockwave 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.

n The operation costs the NHS £4,000 — it is not available privately.

WHAT ARE THE RISKS? 

 A small risk of heart attack and stroke — around one in 300, the same as for any angioplasty procedure (where a stent is inserted).

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.

‘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.’

 

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