Doctors from Kiên Giang General Hospital become the first in the Mekong Delta region using the LithiX HC Mechanical Intravascular Lithotripsy (IVL) Balloon (Elixir Medical, USA). – Photo courtesy of Kiên Gian General Hospital

AN GIANG — The Kiên Giang General Hospital in An Giang Province has become the first medical centre in the Mekong Delta region to successfully treat a heavily calcified coronary lesion using the LithiX HC Mechanical Intravascular Lithotripsy (IVL) Balloon. 

The procedure was performed on a 95-year-old female patient, the oldest in the region, presenting with extremely complex, eccentric calcified lesions, the hospital reported.

The 95-year-old patient, L.T.T. from Rạch Giá Ward, was diagnosed through coronary angiography combined with optical coherence tomography (OCT) imaging with two severe stenotic segments in the left anterior descending artery, each showing over 90 per cent narrowing and a significant mismatch in vessel diameters. The thick, eccentric calcification spanned 280–360° with multiple large nodular calcium deposits – features considered among the most challenging types of calcified lesions for contemporary calcium modification techniques.

Due to her advanced age and high risk of complications, conventional options such as rotational atherectomy, cutting balloons, high-pressure balloons, or other specialised devices were deemed unsuitable.

After a multidisciplinary discussion, the interventional team selected a single LithiX 2.5mm balloon to modify the entire calcified vessel. Owing to its semi-compliant design, the balloon was able to expand flexibly from 2.5mm to over 3.2mm depending on inflation pressure, accommodating both vessel segments with different diameters. During the procedure, nine inflations at 6-12 atm were performed smoothly, achieving uniform calcium modification without causing endothelial injury.

Notably, the hospital’s angiography system enabled exceptionally clear visualisation of the LithiX balloon and its metallic hemispherical elements without image noise.

During the intervention, the patient developed signs of acute myocardial infarction with ST-segment elevation. 

Under the leadership of Dr. Huỳnh Trung Cang, MD, PhD, head of Cardiology Department, together with Dr. Lâm Hữu Giang, the team immediately deflated the IVL balloon to restore flow. Within minutes, the patient stabilised, allowing the team to resume LithiX inflation and complete the procedure without requiring any additional assistive devices.

Post-IVL OCT images confirmed complete calcium fracture, providing optimal vessel preparation for stent deployment.

Following calcium modification, two drug-eluting stents were deployed successfully. OCT imaging demonstrated excellent stent expansion, with the minimum stent area over 98 per cent and 100 per cent stent apposition. The patient was alert immediately after the procedure, hemodynamically stable, and discharged within just 48 hours.

A key highlight is that the entire preparation of this severely calcified lesion required only one LithiX balloon, unlike conventional approaches that often require combinations of rotational atherectomy, scoring/cutting balloons, high-pressure balloons, and multiple adjunctive tools. This new technique reduces procedural costs, shortens procedural time, minimizes radiation exposure, and lowers contrast volume — crucial advantages for elderly patients and provincial hospitals in the Mekong Delta.

“We are proud to be the first centre in the Mekong Delta to fully master the LithiX Hertz Contact technology,” said Dr. Huỳnh Trung Cang, MD, PhD, head of Cardiology, Kiên Giang General Hospital. 

“With a single mechanical IVL balloon, we successfully managed a thick, eccentric calcified lesion, navigated an acute ischemic event, obtained high-quality OCT images, and optimized patient costs. This is a highly suitable solution for elderly patients in the Southwestern region.” – VNS