Cross-Discipline Technology Transfer: A Thankful Urologist
By: Paul Schellhammer, MD; Deepak Talreja, MD, FACC; Ron McKechnie, MD, FACC | Posted on: 01 Feb 2022
In the 1970s the German aviation giant, Dornier, in partnership with German urologists, went out of their scope of industry practice and experimented with shockwave-induced fragmentation of urinary calculi. In 1980, Christian Chaussy et al reported the first clinical use of the prototype HM3 lithotripter to treat renal stone disease.1 Four years later, in March 1984, the first HM3 unit arrived in the United States at the Methodist Hospital in Indianapolis, Indiana and soon thereafter to 4 additional U.S. academic centers. These centers immediately became a magnet for patients seeking a noninvasive method for the treatment of their kidney stones. The approach to this common problem was changed forever. Soon technology modified the bulky HM3 to smaller units.
So why this abbreviated history of the seismic shift in the treatment of urinary calculus disease? The ability to disrupt calcific aggregates has found another home far from the urinary tract, namely to calcifications in the coronary arteries. As in so many areas, miniaturization is key. In this case it made possible the incorporation of shockwave technology to catheters that transverse the coronary arteries.
How did such a catheter address my problem? I experienced the crushing chest pain that I had experienced several times in the past and which had been successfully treated with balloon angioplasty and stent placement. Current coronary angiography revealed “in-stent stenosis” in an area of prior stenting of the left anterior descending coronary artery. Furthermore, this region had developed dense arterial wall calcification in this previously stented area. This rigidity of the calcified artery prevented balloon expansion from dilating the lesion to allow stent placement. The procedure was terminated. The interventional cardiologist then presented me with the choice of coronary artery bypass surgery or the possibility of an intervention using a catheter with shockwave lithotripter capability (Shockwave Medical, Inc., Santa Clara, California). The intravascular lithotripsy catheter contains integrated lithotripsy emitters for the localized delivery of acoustic pressure pulses within the target treatment site. This disrupts calcium within the coronary artery lesion allowing it to yield to dilatation using low balloon pressure. Stents can then be successfully placed. While traditionally studied and approved for dilatation of complex, calcified vessels prior to stent placement, off-label use has included treating previously stented lesions, as in my case.2,3
I expressed wonder and disbelief. I fell back on a familiar statement: “You can’t be serious!” But we are encouraged to listen to our doctors. The catheter was deployed and activated. The calcification within the arterial wall was fragmented and softened, permitting balloon expansion and placement of stents. Interventional cardiology has applied technology born to fragment urinary calculi to a successful cardiac intervention. For innovation, cross-discipline technology and a skilled interventional cardiologist, I am an ever-thankful urologist.
- Chaussy CH, Brendel W and Schmiedt E: Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980; 316: 1265.
- Brinton TJ, Ali ZA, Hill JM et al: Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses: first description. Circulation 2019; 139: 834.
- Hill JM, Kereiakes DJ, Shlofmitz RA et al: Intravascular lithotripsy for treatment of severely calcified coronary artery disease. J Am Coll Cardiol 2020; 76: 2635.