Supported by Elixir Medical Corporation and CVSKL - Cardiac Vascular Sentral Kuala Lumpur, the session featured leading consultant cardiologists Dato’ Dr Tamil Selvan Muthusamy and Datuk Dr Rosli Mohd Ali who shared important insights on the growing prevalence of coronary artery disease (CAD) among younger Malaysians, a worrying trend that calls for greater awareness and timely intervention.
The session also highlighted the latest innovations in interventional cardiology, the bioadaptor and intravascular lithotripsy (IVL) system, both of which represent significant progress over the years in helping patients achieve better outcomes and an improved quality of life.
Dato’ Dr Tamil Selvan Muthusamy, Consultant Cardiologist, Cardiac Vascular Sentral Kuala Lumpur(CVSKL)
Datuk Dr Rosli Mohd Ali, Consultant Cardiologist, Cardiac Vascular Sentral Kuala Lumpur (CVSKL)
Read on for the highlights from the insightful session:
Dato’ Dr Tamil Selvan Muthusamy: The heart muscle is like a pump, and it needs blood supply. The heart muscle in itself contains a huge amount of blood every minute, about five litres of blood. For it to work, it doesn’t get its blood supply from its inner chambers but through three tiny arteries which arise from the big vessel called the aortas. These supply the oxygen and nutrients required for the heart muscle to work, much like any other organ.
So when these arteries are narrowed over a period of time, and the blockages impair the blood flow tothe heart muscle, that is coronary artery disease (CAD).There are many reasons for this to happen. By and large, CAD is a disease underlined by several factors[2]. One is a very strong genetic predisposition, which means that it runs in the family. But there are other factors, for example, diabetes, which is contributing to the increase of heart disease in younger people, in particular in this part of the world. Other associated conditions like hypertension, high cholesterol levels and so on, are also factors.
There is also a very important social aspect to it, and that is, how we conduct our lives[2]. For example, obesity or being overweight, the way we eat, our activities, and other habits like smoking or lack of exercise and a rather sedentary lifestyle. All these are a combination, culminating from a genetic factor, disease factors and our environmental factors and how we conduct ourselves–and all these lead to progressive diseases like coronary diseases. In the most severe form, the plaques within the tiny blood vessels can rupture and form blood clots, and instantaneously stop blood flow to the heart, or what we call a major heart attack[3]. In other cases the blockages can be very insidious, blocking more than 70% of the arteries and only then the individual starts to have discomfort or symptoms that present itself upon exertion; what we call a stable angina[4]. The problem is a lot of people can have severe disease and yet can be relatively asymptomatic, and suddenly one day suffer a major heart attack[3].
Question 2. Heart disease has been around for ages, but now you are seeing younger and younger patients. Dr Rosli, would you like to talk about some patients you have seen?
Datuk Dr Rosli Mohd Ali: Malaysia’s National Cardiovascular Disease Registry is compiled based on data contributed voluntarily by the government hospitals, and some of the private hospitals, including us. The last report said one out of 4 patients are below 50 years of age[5]. So I think that's something that is really concerning, because these are very young patients.
I was just sharing that yesterday, I had four patients who went for angioplasty. Two of them were 48, one was 41, and one medical doctor, 28 years of age. He's not a smoker, he doesn't have any family history, no diabetes, but the only problem is that his cholesterol is very high. So I think one of the things that we need to remember is that these patients are getting younger. It is very important to realize that for males more than 45 years of age, and females at perhaps 50 or even 45 and above, should undergo a checkup, at least to check their cholesterol, diabetes, high blood pressure and so on. For those who are at higher risk, they need to undergo further tests.
For example, one of the tests that has been done fairly commonly, and I think at this point in time, it isacceptable as one of the early investigation would be a multi-slice CT coronary angiogram, and this will be able to outline the blood vessels and see whether there's any blockage[6]. If, let's say there's a blockage, then at least they will know they're required to be treated, to aggressively get their risk factors under control. And the other thing is that if it is severe, they require further evaluation such as a stress test or angiogram[7].
So I believe that this is something very important to note, because in about 20% of patients, the first presentation would be a heart attack, and about one out of five patients do not reach hospital in time. In the past, 10% of patients died within the hospital, but now, because of care, because of angioplasty, the mortality datais only about 6%, so we have actually almost halved the in-hospital mortalities.
Question 3. With CAD presenting in younger and younger patients are you seeing more interventions like angioplastytreatments? And is that really necessity? I mean, if you are 28, can you just have lifestyle modifications, maybe baseline medications that can help with the condition?
Datuk Dr Rosli Mohd Ali: So the aims of treatment are threefold [8]. The first goal of treatment is to relieve symptoms. Medications can help, but procedures like bypass surgery and angioplasty are also effective. The second goal is to reduce the risk of serious events such as heart attack or stroke, which is mainly achieved by addressing risk factors through medicines, a healthy diet, exercise, and maintaining an ideal body weight. The third goal is to improve survival and reduce the risk of death. This is particularly important in high-risk patients, such as those with severe blockages in three major blood vessels or impaired heart function, where medication alone is not enough. In such cases, angioplastyis often considered.
It is important to understand that no treatment is a permanent cure. Even bypass surgeries can fail within months or years, especially when patients return to unhealthy habits like smoking or poor diet. Each treatment, whether medication, angioplasty, or surgery has its own advantages and limitations. As interventional cardiologists, we naturally prefer less invasive approaches, since angioplasty often allows patients to leave the hospital the next day and return to work quickly.
We are also seeing more patients opting for angioplasty, partly because people today are more health-conscious, undergo regular screening, and are better informed about treatment choices. Many patients prefer to avoid surgery, and some are referred to us because their physicians feel angioplasty would be more suitable. Over the years, the number of angioplasty procedures at our hospital has continued to grow, reflecting both greater awareness and confidence in this treatment option.
Question 4. Treating younger patients versus treating older patients; meaning treating someone who's in his 70s and treating someone who's just been diagnosed with CAD at 45; what is the difference, and what is really key when considering treatment approaches?
Dato’ Dr Tamil Selvan Muthusamy: When we look at life expectancy in Malaysia, which is around the mid-70s, a person who reaches 78 or 80 has already surpassed the national average lifespan[9]. So for this group, both extending life and maintaining quality of life become crucial goals. On the other hand, when we treat a 35-or 40-year-old patient, the perspective is different. They potentially have another 40 years ahead of them. Here, treatment must go beyond medication, it also involves psychological and social support. The approach has to be comprehensive.
At the hospital level, we have benefited greatly from scientific and pharmaceutical advances. For instance, modern medications can now reduce bad cholesterol to levels; once thought impossible. Clinical skills have also advanced: decades ago, angioplasty and bypass surgery were rare or high-risk for young patients, but today, with experience and improved techniques, these procedures areroutine, minimally invasiveand much safer[10].
A major breakthrough in cardiology was the introduction of stents. In the early days of angioplasty, we used only balloons to open arteries. This was risky; around 5% of patients would need emergency bypass surgery if the artery tore or collapsed[11]. With stents, however, arteries could be held open, dramatically reducing complications.
Still, early stents had problems with re-narrowing due to scar-like healing[11]. The next leap forward was drug-coated stents, which slowed the healing process and reduced recurrence. More recently, we’ve moved toward drug-coated balloons and newer types of stents, such as bioadaptors, which provide flexibility and reduce long-term complications like restenosis.
Even so, challenges remain. For younger patients, recurrence is inevitable as there is no permanent cure. Even after successful stenting, about 2% of patients per year develop restenosis[12], which means up to 25%of patients with a stentmay need further intervention within 10 years[14]. In addition, new blockages can form in other arteries.
This is why our focus must not only be on hospital-based treatment and technology, but also onnational-level prevention. Lifestyle factors such as smoking cessation, exercise, healthy diet, and weight managementare critical[3]. Without serious investment in prevention, medical advances alone cannot solve the problem.
Question 5. We are looking at long-term issues that have persisted even with the best stent technology, including drug-eluting stents. What problems do you see?
Datuk Dr Rosli Mohd Ali: I believe that the initial complications we see are often due to stents not being optimally deployedor fully expanded. When this happens, the risk of early blood clot formation, especially within the first month after implantation increases significantly.
To reduce this risk, we now rely much more on advanced imaging techniques. For example, we use intravascular ultrasound (IVUS) oroptical coherence tomography (OCT)[13]. These involve placing a small catheter inside the blood vessel, which allows us to visualize the artery from within. With this, we can accurately measure the vessel size, determine the exact length of the lesion, and assess themorphology, whether it is calcified, fibrotic, or a softer plaque.
After implanting a stent, we can re-examine the vessel using these imaging tools to check how well the stent has expanded and whether the treatment has been optimally performed. This greatly reduces the risk of early clot formation and also improves long-term outcomes for patients, a benefit that has been consistently demonstrated in multiple studies. However, angioplasty and stenting are not cures. Over time, disease recurrence is common. The challenge with long-term outcomes is that once a stent, which is a foreign metallic structure is placed, treating restenosis becomes more difficult[14].
Importantly, not all recurrences happen at the treated site. Around 50% of new blockages occur in other parts of the coronary arteries[15]. This means that even ifthe original site remains stable, progression of disease elsewhere is highly likely. Ten years after an angiogram, vessels will inevitably have changed and often worsened, leading to more lesions and more complex treatment. Naturally, this results in poorer long-term outcomes.
This is why two things are crucial: firstly, optimal stent implantation and imaging-guided treatment to achieve the best immediate results. Secondly, patient’s responsibility, as long-term success depends heavily on patients maintaining good lifestyle practices and adhering to medical therapy to slowdisease progression.
Question 6. I think you’re one of the top three users of the bioadaptor technology. What has prompted you to make this change for your patients?
To reduce this risk, we now rely much more on advanced imaging techniques. For example, we use intravascular ultrasound (IVUS) oroptical coherence tomography (OCT)[13]. These involve placing a small catheter inside the blood vessel, which allows us to visualize the artery from within. With this, we can accurately measure the vessel size, determine the exact length of the lesion, and assess themorphology, whether it is calcified, fibrotic, or a softer plaque.
After implanting a stent, we can re-examine the vessel using these imaging tools to check how well the stent has expanded and whether the treatment has been optimally performed. This greatly reduces the risk of early clot formation and also improves long-term outcomes for patients, a benefit that has been consistently demonstrated in multiple studies. However, angioplasty and stenting are not cures. Over time, disease recurrence is common. The challenge with long-term outcomes is that once a stent, which is a foreign metallic structure is placed, treating restenosis becomes more difficult[14].
Importantly, not all recurrences happen at the treated site. Around 50% of new blockages occur in other parts of the coronary arteries[15]. This means that even ifthe original site remains stable, progression of disease elsewhere is highly likely. Ten years after an angiogram, vessels will inevitably have changed and often worsened, leading to more lesions and more complex treatment. Naturally, this results in poorer long-term outcomes.
This is why two things are crucial: firstly, optimal stent implantation and imaging-guided treatment to achieve the best immediate results. Secondly, patient’s responsibility, as long-term success depends heavily on patients maintaining good lifestyle practices and adhering to medical therapy to slowdisease progression.
Question 6. I think you’re one of the top three users of the bioadaptor technology. What has prompted you to make this change for your patients?
Dato’ Dr Tamil Selvan Muthusamy: We began using bioadaptors only after seeing some early results, because we wanted to be surethey were safe and effective. To understand why they matter, it helps to know how arteries work. Anartery isn’t just a simple pipe, it’s a living structure. It naturally expands, contracts, and adapts tochanges in blood flow. With traditional stents (the tiny metal“cages”doctors put in to keep arteriesopen), blood can flow, but the artery loses its natural flexibility[16]. It can’t expand any further if needed, which limit show well it can adapt over time.
Bioadaptors were created to overcome this problem [17;18]. A bioadaptorworks by first acting like a drug-eluting stent (DES) to keep a blocked coronary artery open, while also releasing medication to prevent abnormal growth. After about six months, a special bioresorbable polymer coating dissolves, unlocking the bioadaptor's helical strands. This "uncaging" allows the artery to regain its naturalpulsatility, compliance, and adaptive remodeling, restoring normal vessel motion and function rather than maintaining a rigid implant. Unlike metallic stents that remain rigid for a lifetime, the bioadaptor's unique "uncaging" mechanism enables the artery to restore its normal physiological functions overtime.
We’ve tested this in our hospital with advanced imaging cameras placed inside the artery. We found that, one year later, arteries treated with bioadaptors were actually bigger and healthier compared to those treated with regular stents[18]. This explains why clinical trials are showing fewer heart attacks and fewer cases of arteries blocking up again.
Although this technologyis quite new, the three-year results are very encouraging[19]. We’re hopeful that over the next three to five years, patients with bioadaptors will do even better than those with conventional stents.
Question 7. So I understand that one of the complicationsthatcan happen with CAD is the presence of calcified coronary lesions or CCL. Tell us more about how this can affect stentprocedures and CAD in general?
Datuk Dr Rosli Mohd Ali: When cholesterol builds up in the arteries, calcium often gets deposited into these plaques as well. Conditions like kidney disease, diabetes, and smoking make this worse. When calcium hardens inside the artery, it makes treatment much more difficult[20]. Because of this, the stent may not expand properly once inserted, which increases the risk of blood clots and the artery narrowing again later.
Traditionally, we try to crack the calcium using special high-pressure balloons or other tools like atherectomy devices (tiny drills or blades)[21]. But these methods can be risky as balloons can burst, arteries can tear, and the procedures are technically demanding. Because of this, many doctors hesitate to use them unless absolutely necessary.
A newer technology, called intravascular lithotripsy (IVL), uses ultrasound waves from inside a balloon to break the calcium so the artery can be opened safely. However, IVL balloons are expensive, can only deliver a limited number of pulses, and sometimes we need more than one balloon to treat long or very hard lesions[21].
Recently, an even newer device has been introduced: the mechanical lithotripsy balloon(mechanicalIVL System)[22]. This balloon can crack the calcium at a much lower pressure than traditional balloons, making it safer and easier to use. It can be reused multiple times in the same procedure, it works well even in long or very calcified lesions, and it is more economical than the older devices.
Our centre was the first in Asia-Pacific to use this device(mechanical IVL System), and one of the first in the world to demonstrate it live at an international conference. So far, we’ve treated almost 90 patients with CCL using this device, and the results have exceeded expectations. Using imaging tests we can see the calcium is effectively shattered, allowing stents to expand properly. Sometimes a stent isn’t even needed at all. We believe this breakthrough technology has the potential to replace many older, more complicated tools for treating heavily calcified arteries[22].
Question 8. So we are looking at two technologies: One, the bioadaptor, mentioned earlier, and secondly the mechanical lithotripsy. So perhaps you can explain again, how mechanical lithotripsy works and why is it important?
Bioadaptors were created to overcome this problem [17;18]. A bioadaptorworks by first acting like a drug-eluting stent (DES) to keep a blocked coronary artery open, while also releasing medication to prevent abnormal growth. After about six months, a special bioresorbable polymer coating dissolves, unlocking the bioadaptor's helical strands. This "uncaging" allows the artery to regain its naturalpulsatility, compliance, and adaptive remodeling, restoring normal vessel motion and function rather than maintaining a rigid implant. Unlike metallic stents that remain rigid for a lifetime, the bioadaptor's unique "uncaging" mechanism enables the artery to restore its normal physiological functions overtime.
We’ve tested this in our hospital with advanced imaging cameras placed inside the artery. We found that, one year later, arteries treated with bioadaptors were actually bigger and healthier compared to those treated with regular stents[18]. This explains why clinical trials are showing fewer heart attacks and fewer cases of arteries blocking up again.
Although this technologyis quite new, the three-year results are very encouraging[19]. We’re hopeful that over the next three to five years, patients with bioadaptors will do even better than those with conventional stents.
Question 7. So I understand that one of the complicationsthatcan happen with CAD is the presence of calcified coronary lesions or CCL. Tell us more about how this can affect stentprocedures and CAD in general?
Datuk Dr Rosli Mohd Ali: When cholesterol builds up in the arteries, calcium often gets deposited into these plaques as well. Conditions like kidney disease, diabetes, and smoking make this worse. When calcium hardens inside the artery, it makes treatment much more difficult[20]. Because of this, the stent may not expand properly once inserted, which increases the risk of blood clots and the artery narrowing again later.
Traditionally, we try to crack the calcium using special high-pressure balloons or other tools like atherectomy devices (tiny drills or blades)[21]. But these methods can be risky as balloons can burst, arteries can tear, and the procedures are technically demanding. Because of this, many doctors hesitate to use them unless absolutely necessary.
A newer technology, called intravascular lithotripsy (IVL), uses ultrasound waves from inside a balloon to break the calcium so the artery can be opened safely. However, IVL balloons are expensive, can only deliver a limited number of pulses, and sometimes we need more than one balloon to treat long or very hard lesions[21].
Recently, an even newer device has been introduced: the mechanical lithotripsy balloon(mechanicalIVL System)[22]. This balloon can crack the calcium at a much lower pressure than traditional balloons, making it safer and easier to use. It can be reused multiple times in the same procedure, it works well even in long or very calcified lesions, and it is more economical than the older devices.
Our centre was the first in Asia-Pacific to use this device(mechanical IVL System), and one of the first in the world to demonstrate it live at an international conference. So far, we’ve treated almost 90 patients with CCL using this device, and the results have exceeded expectations. Using imaging tests we can see the calcium is effectively shattered, allowing stents to expand properly. Sometimes a stent isn’t even needed at all. We believe this breakthrough technology has the potential to replace many older, more complicated tools for treating heavily calcified arteries[22].
Question 8. So we are looking at two technologies: One, the bioadaptor, mentioned earlier, and secondly the mechanical lithotripsy. So perhaps you can explain again, how mechanical lithotripsy works and why is it important?
Dato’ Dr Tamil Selvan Muthusamy: Calcium in the arteries isn’t soft like butter or cheese, it’s more like cement. In the past, the way to treat this was by drilling through the calcium with a device called a rotablator[23]. It worked, but it was complicated and came with higher risks, and many doctors were reluctant to use it.
Later, we moved to new methods like balloons with tiny wires that cut the calcium, and then to ultrasound balloons, which work like the shockwaves used to break kidney stones. These can crack the calcium but have drawbacks: they’re bulky, difficult to move through arteries, and each balloon can only deliver a limited number of “pulses.” If the calcium doesn’t break after that, you need to usea nother balloon, which becomes very expensive[21].
Now we have a newer approach: mechanical lithotripsy, where the balloon inflates and press directly against the calcium with a force many times stronger than before, cracking it without the need for an external energy source. It’s simpler, safer, and easier to deliver through the arteries[22].
Why does this matter? Because the success of angioplasty depends on how well the stent expands. If calcium blocks proper expansion, the risks of blood clots and re-narrowing (restenosis) are much higher. By breaking the calcium first, mechanical lithotripsy allows the stentor bioadaptorto expand fully, leading to much better long-term outcomes[22].
Question 9. Please share with us one or two examples of patients who have been implanted with the bioadaptor or used the mechanical IVL system.
Later, we moved to new methods like balloons with tiny wires that cut the calcium, and then to ultrasound balloons, which work like the shockwaves used to break kidney stones. These can crack the calcium but have drawbacks: they’re bulky, difficult to move through arteries, and each balloon can only deliver a limited number of “pulses.” If the calcium doesn’t break after that, you need to usea nother balloon, which becomes very expensive[21].
Now we have a newer approach: mechanical lithotripsy, where the balloon inflates and press directly against the calcium with a force many times stronger than before, cracking it without the need for an external energy source. It’s simpler, safer, and easier to deliver through the arteries[22].
Why does this matter? Because the success of angioplasty depends on how well the stent expands. If calcium blocks proper expansion, the risks of blood clots and re-narrowing (restenosis) are much higher. By breaking the calcium first, mechanical lithotripsy allows the stentor bioadaptorto expand fully, leading to much better long-term outcomes[22].
Question 9. Please share with us one or two examples of patients who have been implanted with the bioadaptor or used the mechanical IVL system.
Datuk Dr Rosli Mohd Ali: About one-third of heart patients have calcium build-up in their arteries. A couple of years ago, CVSKL was only treating around 13% of these cases, which was already more than the national average. But now, as we take on more complex cases and have better tools, we’re treating many more patients with calcium problems.
In the past, we often had to use devices like drills (rotablator, orbital atherectomy) to shave off or break the calcium[21]. But with the introduction of mechanical lithotripsy[22], we’re using those older tools less. The reason is simple: this new method is easier, safer, and something we’re already familiar with, because it works just like inflating a normal balloon during angioplasty. It allows us to treat even heavily calcified arteries more efficiently, shortens the procedure time, and reduces complications.
For example, the case we did yesterday involved a 48-year-old patient with a completely blocked and heavily calcified artery which is a 100% occlusion. The first challenge in such cases is to pass the wire through the true vessel channel, because with total blockages, the wire often slips into the wrong path outside the artery. Once we successfully guided the wire into the vessel, we attempted balloon dilation. However, the balloon couldn’t expand properly due to the dense calcium.
This was exactly the type of situation where we used themechanical lithotripsy balloon. As we inflated the balloon, we saw a “waist” on the angiogram image, a sign that the calcium was resisting expansion. But with gradual increases in pressure, the waist suddenly gave way, confirming that the calcium had been cracked. Once the calcium was fractured and the vessel prepared, we were confident to implant the stent. The final result was excellent, both angiographically and clinically.
Question 10. What was his lifestyle, dietary habits like? Did he work in ahigh stress environment?
In the past, we often had to use devices like drills (rotablator, orbital atherectomy) to shave off or break the calcium[21]. But with the introduction of mechanical lithotripsy[22], we’re using those older tools less. The reason is simple: this new method is easier, safer, and something we’re already familiar with, because it works just like inflating a normal balloon during angioplasty. It allows us to treat even heavily calcified arteries more efficiently, shortens the procedure time, and reduces complications.
For example, the case we did yesterday involved a 48-year-old patient with a completely blocked and heavily calcified artery which is a 100% occlusion. The first challenge in such cases is to pass the wire through the true vessel channel, because with total blockages, the wire often slips into the wrong path outside the artery. Once we successfully guided the wire into the vessel, we attempted balloon dilation. However, the balloon couldn’t expand properly due to the dense calcium.
This was exactly the type of situation where we used themechanical lithotripsy balloon. As we inflated the balloon, we saw a “waist” on the angiogram image, a sign that the calcium was resisting expansion. But with gradual increases in pressure, the waist suddenly gave way, confirming that the calcium had been cracked. Once the calcium was fractured and the vessel prepared, we were confident to implant the stent. The final result was excellent, both angiographically and clinically.
Question 10. What was his lifestyle, dietary habits like? Did he work in ahigh stress environment?
Datuk Dr Rosli Mohd Ali: Well, he was a diabetic, and diabetes is in Malaysia is high, where about50% of patients that undergo PCR angioplasty are diabetics[24]. That's rather high. In Europe, it's only about 20 or 25%[25]. The patient is also a smoker, and obviously his cholesterol is very high.
Dato’ Dr Tamil Selvan Muthusamy: Let me give you another example. I had a relatively young doctor who was frequently admitted with recurrent chest pain. His issue was a large side branch of the main artery, what we call a diagonal branch. It was not only relatively small but also very tortuous(abnormally twisted, elongated, dilatedvessel), which made it technically challenging to treat. In such vessels, many patients are managed with medication alone, because interventions can be risky. If we try a drug-coated balloon, which is often preferred in these cases, the vessel’s natural twists and turns increase the risk of tearing, and the results are usually poor. We therefore needed a solution that could provide durable, long-term benefit.
For this patient, I chose to implant a bioadaptor. It was a challenging procedure, but we reviewed him one year later and saw two key results, which are: firstly, no restenosis, despite the vessel being small and tortuous; and secondly, the device demonstrated its unique ability to adapt and remodel with the vessel wall. In fact, the lumen(vessel) was larger than it had been immediately after implantation, which partly explains the excellent outcome.
In total, we’ve implanted about 485 bioadaptors in our patients and continue to follow them closely. While five-year data will give us the most complete picture, so far only one patient has shown restenosis, which is extremely encouraging.
As for mechanical lithotripsy, our initial approach was to reserve it only for “undilatable” vessels,where no balloon could expand. But our concept has evolved. Now, even in cases where standard balloons work, we use mechanical lithotripsy to crack the calcium more effectively, which improves lumen expansion and long-term outcomes. This has been consistently confirmed with intravascular ultrasound.
This combination of bioadaptors and mechanical lithotripsy represents a powerful advance: fast, effective, and safe, exactly what interventional cardiologists want.
References:
1. https://english.news.cn/20231030/d4d66f8967aa49fc92d8784808523feb/c.html
2. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
3. https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-
20373106
4.
https://www.health.harvard.edu/heart-health/living-with-stable-angina
5.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11085987/
6.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2998832/
7.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3366298/
8.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2016934/#:~:text=The%20goals%20of%20medical%20
9. https://open.dosm.gov.my/dashboard/life-expectancy
10. https://my.clevelandclinic.org/health/treatments/22060-angioplasty
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC5808490/#:~:text=Interventional%20cardiologists%20who%20have%20been,incidence%20of%20thrombosis%20and%20restenosis.
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC4315466/
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC7411139/#:~:text=Intravascular%20ultrasound%20(IVUS)%20and%20optical,system%20in%20the%20clinical%20field.
14. https://www.sciencedirect.com/science/article/pii/S1936879823013924
Dato’ Dr Tamil Selvan Muthusamy: Let me give you another example. I had a relatively young doctor who was frequently admitted with recurrent chest pain. His issue was a large side branch of the main artery, what we call a diagonal branch. It was not only relatively small but also very tortuous(abnormally twisted, elongated, dilatedvessel), which made it technically challenging to treat. In such vessels, many patients are managed with medication alone, because interventions can be risky. If we try a drug-coated balloon, which is often preferred in these cases, the vessel’s natural twists and turns increase the risk of tearing, and the results are usually poor. We therefore needed a solution that could provide durable, long-term benefit.
For this patient, I chose to implant a bioadaptor. It was a challenging procedure, but we reviewed him one year later and saw two key results, which are: firstly, no restenosis, despite the vessel being small and tortuous; and secondly, the device demonstrated its unique ability to adapt and remodel with the vessel wall. In fact, the lumen(vessel) was larger than it had been immediately after implantation, which partly explains the excellent outcome.
In total, we’ve implanted about 485 bioadaptors in our patients and continue to follow them closely. While five-year data will give us the most complete picture, so far only one patient has shown restenosis, which is extremely encouraging.
As for mechanical lithotripsy, our initial approach was to reserve it only for “undilatable” vessels,where no balloon could expand. But our concept has evolved. Now, even in cases where standard balloons work, we use mechanical lithotripsy to crack the calcium more effectively, which improves lumen expansion and long-term outcomes. This has been consistently confirmed with intravascular ultrasound.
This combination of bioadaptors and mechanical lithotripsy represents a powerful advance: fast, effective, and safe, exactly what interventional cardiologists want.
References:
1. https://english.news.cn/20231030/d4d66f8967aa49fc92d8784808523feb/c.html
2. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
3. https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-
20373106
4.
https://www.health.harvard.edu/heart-health/living-with-stable-angina
5.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11085987/
6.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2998832/
7.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3366298/
8.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2016934/#:~:text=The%20goals%20of%20medical%20
9. https://open.dosm.gov.my/dashboard/life-expectancy
10. https://my.clevelandclinic.org/health/treatments/22060-angioplasty
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC5808490/#:~:text=Interventional%20cardiologists%20who%20have%20been,incidence%20of%20thrombosis%20and%20restenosis.
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC4315466/
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC7411139/#:~:text=Intravascular%20ultrasound%20(IVUS)%20and%20optical,system%20in%20the%20clinical%20field.
14. https://www.sciencedirect.com/science/article/pii/S1936879823013924
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