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. 2023 Apr;14(2):149-152.
doi: 10.14740/cr1489. Epub 2023 Apr 8.

Sodium Chloride Physiological Saline Solution Versus Water Preparations Injectable in the Use of Shockwave Intravascular Lithotripsy: A Single-Center Experience

Quentin Landolff  1 , Matthieu Godin  1 , Alexandre Canville  1 , Benjamin Honton  2 , Jacques Monsegu  3 , Marine Quillot  4 , Jacques Berland  1 , Rene Koning  1 , Nicolas Amabile  5
Affiliations

Sodium Chloride Physiological Saline Solution Versus Water Preparations Injectable in the Use of Shockwave Intravascular Lithotripsy: A Single-Center Experience

Quentin Landolff et al. Cardiol Res. 2023 Apr.

Abstract

Background: Shockwave intravascular lithotripsy (IVL) coronary system is a very useful new technology for de novo severely calcified coronary artery plaques before percutaneous coronary intervention (PCI). The device uses a semi-compliant low-pressure balloon, integrated into a sterile catheter, to deliver by vaporizing fluid an expanding bubble that generates high-pressure ultrasonic energy by waves that create multiplane longitudinal micro-macro fractures in calcified plaques, which facilitate optimal stent placement and expansion, and luminal gain.

Methods: The use of Shockwave IVL coronary system in our cardiac catheterization laboratory (Cath lab) at the "Clinique Saint-Hilaire" in Rouen, France, started in March 2019, with 42 procedures performed since this date: two patients in 2019, two patients in 2020, seven patients in 2021, 23 patients in 2022, and eight patients since the beginning of 2023.

Results: We had experienced problems at the beginning of our activity for the first 11 patients (two patients in 2019, two patients in 2020, and seven patients in 2021): after less than five pulses, the shock therapy stopped. We used initially for Shockwave IVL semi-compliant low-pressure integrated balloons a mixture of 50% contrast and 50% water preparations injectable (PPI). After changing water PPI by sodium chloride physiological saline solution, we never encountered this problem again for the following 31 patients (23 patients in 2022, and eight patients since the beginning of 2023). In fact, the proper functioning of Shockwave IVL system requires ions in balloon mixture in addition to the contrast. It is thanks to the ions contained in sodium chloride physiological saline solution that the spark necessary for shocks delivery after balloon inflation is produced.

Conclusions: Water PPI or sodium chloride physiological saline solution is used in angioplasty balloons in a lot of Cath labs worldwide. It is therefore essential to disseminate in the worldwide Cath lab the obligation to put in Shockwave IVL semi-compliant low-pressure integrated balloons sodium chloride physiological saline solution, rather than water PPI for optimal performance, and the importance of Shockwave Medical reporting this to interventional cardiologists.

Keywords: Angioplasty; Calcified coronary artery; Shockwave intravascular lithotripsy.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
The shock therapy stopped after less than five pulses with Shockwave IVL coronary system, during inflation of Shockwave IVL semi-compliant low-pressure integrated balloon with a mixture 50% contrast and 50% water PPI for the first 11 patients (two patients in 2019, two patients in 2020, and seven patients in 2021). IVL: intravascular lithotripsy.
Figure 2
Figure 2
No pulse malfunction with Shockwave IVL coronary system was noted during inflation of Shockwave IVL semi-compliant low-pressure integrated balloon with a mixture 50% contrast and 50% sodium chloride physiological saline solution for the following 31 patients (23 patients in 2022, and eight patients since the beginning of 2023). IVL: intravascular lithotripsy.
See this image and copyright information in PMC

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