Jade Broody and Kristi Seiler – Speakers 2022 Fall

Jade Broody, BSRT (R) (RCIS)

Email: jadepbroody@gmail.com

Bio: Misericordia University Medical Imaging Graduate, Class of 2019. I specialized in the cardiac cath lab and became certified as a Registered Cardiovascular Invasive Specialist.

Place of Employment: Geisinger Wyoming Valley Medical Center in the Cardiac Catheterization Lab. GWV is a Level I trauma center and a comprehensive cardiac hospital. GWV cath lab runs 24/7 with staff on call for all cardiac emergencies.


Kristi Seiler BSRT (R) (RCIS)

Email: seilerk@live.com

Brief Bio: Misericordia Medical Imaging Class of 2015, Registered Cardiovascular Invasive Specialist at Geisinger Wyoming Valley Cath Lab since 2016

Place of Employment: Geisinger Wyoming Valley Medical Center – Cardiac Catheterization Lab

Lecture Title – Intravascular Lithotripsy: A Shockingly Innovative and Effective Take on Conventional Cardiovascular Methods

Presentation Objectives:

  1. Depict the concepts of the cardiac catheterization lab to establish basic purpose of daily operations.
  2. Recall and Assess previous methods of treating severe cardiac disease
  3. Illustrate the method of lithotripsy and its integration into cardiovascular care
  4. Review case studies, interpret data, and further analyze future applications


  1. Describing basic background of the cardiac catheterization lab
  2. What is the cath lab and what does a catheterization entail?
  3. Cardiac catheterization is a procedure where access is gained into either an artery or a vein. A tube called a catheter is inserted and guided to the heart using a wire
  4. Most common arterial access sites is radial and femoral artery
  • Terminology (heart and vessel anatomy, etc)
  1. A catheterization is used to diagnose or treat certain heart conditions, such as coronary arteries disease, CAD (also called atherosclerosis), valvular disease and heart failure. Helpful information is obtained in the procedure to further treat patients with ongoing heart conditions
  2. During a catheterization it is not just diagnostic but also interventional which means a problem can be fixed while at the time of the catheterization
  3. The procedure can be done as an outpatient which means you can come and go the same day. Sedation could be administered to relax the patient but not put them sleep. Just like taking an ordinary x-ray, patients are sometime asked to move their head left or right, hold their breath or follow commands to obtain the best possible imagery
  4. What is coronary artery disease?
  5. Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease. CAD is also referred to as atherosclerosis
  6. CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart. These vessels are called your coronary arteries
  • Terminology (stenosis, lesion, narrowing, concentric, eccentric)
  1. Plaque is made up of deposits of cholesterol and other substances. Plaque buildup causing the inside of the vessel to become narrow over time. This could partially or totally block the blood flow. This process of the plaque building up on the vessels is called atherosclerosis
  2. What is a PCI?
  3. PCI stands for Percutaneous Coronary Intervention
  4. Balloon angioplasty is the first step. The process entails putting extremely small wires (.014 of an inch) into the artery and tracking a balloon over that wire. The balloon is then inflated where the blockage is to break apart the plaque and restore blood flow
  • After the plaque is be disrupted, it is typical to place a stent in the area. Disrupting luminal changes creates an inflammatory response from the body. Stents assist in keeping that blockage open longer than just inflating a balloon (stents used are drug coated)
  1. Describe previous methods of treating severe disease – In some instances plaque can be too tough to break through with just a balloon
  2. Orbital Atherectomy, Rotopro, and Cutting balloons
  3. Atherectomy was one of the most common methods to breakthrough difficult plaque in vessels
  4. The devices utilize a diamond tip called a burr that spin and rotates at a very fast rate and breaks through heavily calcified lesions (it breaks plaque down to microscopic pieces that eventually filtered out through the kidney’s)
  • Cutting balloons use the concept of balloon angioplasty but this balloon is lined with a blade like mechanism called Atherotome’s which will cut through the tough plaque to loosen and open the lumen of the vessel
  1. Pros & cons
  2. Expense, complexity, doctor training, risk of dissection
  3. What is Lithotripsy? – use of pulsatile sonic waves to disrupt calcified plaque with minimal vessel injury
    1. Previous Urologic Uses
      1. Used to fracture renal calculi (aka kidney stones) into smaller pieces that can be filtered through the urinary system
      2. First introduced in 1980s
  • Non-invasive treatment in comparison to surgical incision
  1. New Uses in Vascular system (peripheral/coronary)
    1. Developed into a Balloon Catheter that passes over a 0.014” Guidewire into a calcific vessel
      1. Cable connects balloon catheter via magnet, attaches into IVL Generator Box
      2. Once Connected, Catheter registers to generator box and allows physician option to pass shockwaves (aka intravascular lithotripsy) into effected lesion once balloon is inflated
    2. Acoustic pressure waves modify calcific plaque in order to enhance vessel compliance and optimize proper stent deployment
  • Uses Pre TAVR/EVAR to enhance vessel compliance for large Bore sheaths for procedure
  1. Uses in Occlusive Disease in Peripheral
    1. Provides endovascular option for patients who otherwise could not receive open surgical procedure due to patient risks (anesthesia compliance, obesity, heart disease, lung compacity, etc.)
    2. Primary uses in Iliac, Femoral, and Popliteal Arteries
  2. Uses in Highly Calcified Disease in Coronary
    1. Provides less invasive method of intervention in comparison to possible alternatives like Coronary Bypass Surgery
      1. Could be more reasonable option of care to patient with specific risk factors inhibiting them to have other treatment
    2. Low pressure Balloon Platform – contributes to lower instance of dissection or perforation by avoiding barotraumatic vessel wall injuries related to high pressure inflations
  3. Indications
    1. Calcific lesions where a 0.014” guidewire can safely be placed across
  4. Contraindications
    1. Carotids
    2. Coronary In-Stent Restenosis
  • In any lesion where a 0.014” guidewire cannot be safely placed across
  1. Describe Case Studies and Data Collected
  1. Disrupt CAD III Study
    1. Pros
      1. Freedom from Major Adverse Cardiovascular Events post IVL PCI – 92.2%
      2. Effectiveness of procedural success – 92.4%
      3. Successful IVL Crossing and therapy delivery in 98% of lesions with 99% with successful stent delivery
      4. Low Risk Of Perforation (0.3%), major dissection (0.3%), abrupt closure (0.3%), and Slow Flow/No Flow (0.0%) at end of case
      5. >80% Operators had no prior experience with IVL, yet Procedural success and device crossing success were similar between first case and pivotal cohort
    2. Cons
      1. Non-randomized trial
      2. Longer Term Clinical Follow Up Data is Ongoing (will better interpret durability and longevity)
    3. Disrupt PAD III Study
      1. Demonstrated significantly lower dissections (by 77%), with low complications (no reported instances of distal embolization, no-flow, or abrupt closure events), and improved primary patency over time versus standard balloon angioplasty
    4. Possible Future Approved Uses
      1. Treatment of Aortic Stenosis
      2. Unprotected Left Main PCI
  • Chronic Total Occlusions