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LIST OF PRODUCTS
 
 
 
 
Cardiology
World's first shock wave device for cardiology
 
  • Oveerview
  • MODULITH SLC
  • FAQs
 
 
In 1999, STORZ MEDICAL was the first manufacturer worldwide to introduce a cardiological shock wave system for the treatment of refractory angina pectoris. During the last few years, the company has conducted ongoing research in close co-operation with leading medical institutes and continuously improved shock wave therapy for cardiological applications.
Today, many renowned therapy centres use the innovative MODULITH® SLC with great success in the treatment of Non-revascularizable Angina Pectoris, Ischemic Heart Disease (HF), No-reflow after PCI, Diffuse Coronary Artery Disease.
 
 
Innovation and experience
   
The MODULITH® SLC is the world’s first shock wave device for the treatment of refractory angina pectoris.
Controlled application of precisely levelled shock wave pulses on ischemic areas of the heart muscle generates new capillaries (neo-angiogenesis) and increases circulation and metabolism. The effect is significant and lasting. Several thousand shock waves are delivered to the ischemic area under simultaneous inline-ultrasound control. ECG-triggering ensures shock wave release only during refractory period of the cardiac cycle, avoiding arrhythmic irritations. Significant reduction of complaints and enhanced cardiac function are achieved. The treatment modality does not require anaesthesia and is essentially free of side effects.
 
Versatility
Ergonomic  

The shock wave source of the MODULITH® SLC is mounted to a balanced articulated arm with hydraulic brakes. The device can be positioned and directed smoothly without effort. According to patients anatomy optimal positions and directions of shock wave access may be selected. Fine adjustment is controlled by a separate manual scanning mechanism. Minimal change of position and direction with the therapy head ensures optimal visualisation and control with ultrasound. Last but not least, individually matched shock waves are released and triggered by ECG to avoid risky interference with cardiac cycle of the patient.The whole device is built in a trolley to be easily moved into its operation position and stored when not in use.

 
Shock wave source
   
Like all STORZ MEDICAL shock wave machines the MODULITH® SLC is equipped with the patented electromagnetic cylindrical shock wave generator. Due to its excellent dosage and stability, shock wave pulses are precisely matched to the individual anatomical conditions. Ischemic areas of the myocardium are selected and exposed to controlled levels of shock wave energy. The cylindrical configuration enables in-line integration of ultrasound transducers for simultaneous observation of the shock wave, passing from skin to myocardium.
   
The shock wave field is directed according to the live ultrasound image to avoid obstructing bones of the ribcage as far as possible and to keep lung tissue out of the shock wave pass. An important feature of the specific shock wave generator design is its ability to select an extremely wide range of energy levels. For cardiac application very low energy levels should be selected to start with to be followed by a gradual increase to therapeutic levels. Shock wave energy delivered remains precisely on the adjusted level, unless willingly modified. Energy fluctuations as common with ordinary shock wave generators are prevented by the unique design of the STORZ MEDICAL cylinder source.
   
 
Cardiology: Myocardial ischemia due to coronary artery blockage.
 
What is Myocardial ischemia?

Myocardial ischemia occurs when blood flow to heart muscle is reduced by partial/complete blockage in an artery supplying blood to your heart (coronary artery). Decrease in blood flow reduces oxygen supply to heart, which damage the heart muscles and reduces hearts ability to pump efficiently.
A sudden, severe blockage of coronary artery leads to ‘Heart Attack’

 
 

            

 
What are the symptoms of Myocardial ischemia?
Chest pain ( left side of body)
Neck/jaw pain
Shoulder pain
Shortness of breath
Nausea and vomiting
 
Some people having myocardial ischemia don’t experience any of the above symptoms, which is termed as silent ischemia.
 
Which conditions cause Myocardial ischemia?
Coronary artery disease (CAD/atherosclerosis) - It occurs when plaques made of cholesterol and other cellular waste products build on coronary arteries and decrease the blood flow. This is the most common cause of myocardial ischemia.
   
Blood clot The plaques that develop in atherosclerosis can rupture and cause blood clot, which may lead to sudden heart attack.
   
Coronary artery spasm – it is temporary tightening of the artery walls, which narrows and decrease/prevent blood flow to heart muscles.
   
Other Severe illness - It occurs when metabolic demands increase and when blood pressure is low due to infection, bleeding and other severe illness.
 
Do I have the risk of getting Myocardial ischemia?
There are certain factors that may increase your risk of getting Myocardial ischemia. They are -
Smoking
Diabetes
High Blood Pressure
High blood cholesterol or triglyceride level
Lack of physical activity
Obesity
Family history
 
What are the complications, if I don’t take treatment on time?
Heart attack : If the coronary artery is blocked completely, the sudden supply of blood and oxygen will lead to heart attack that destroys the part of heart muscle causing serious and fatal damage to heart.
Heart muscle injury : It can reduce the blood pumping capability of heart and over the period of time may result in ‘Heart failure’.
Irregular heart rhythm : When heart does not receive adequate blood supply, the electrical impulses that coordinate the heart beats may malfunction. This may cause heart to beat too fast or too slow or irregularly.
 
What is the conventional treatment for Myocardial ischemia?
Treatment of Myocardial ischemia mainly focuses on improving blood flow to affected heart muscles. Depending on the severity, your condition will be treated by medication, surgery or both.
 
Angioplasty and stenting
In this procedure, a catheter is passed into narrowed part of your artery. Through this catheter a wire with tiny deflated balloon is passed. The balloon is inflated to widen the artery and a small mesh is inserted to keep the artery open.
 
 
Risks associated with angioplasty and stenting-
Allergic reaction to drugs, stent material and x-ray dye.
Bleeding/clotting at the catheter insertion site.
Clogging of stent (in-stent restinosis)
Heart attack.
Damage to heart valve or blood vessels
Kidney failure.
Irregular heartbeats.
Stroke.
 
Coronary artery bypass surgery
It is open- heart, high risk surgery in which a graft is used to bypass the blocked coronary artery. This makes an altogether new path for blood around the narrowed artery.
 
 
Risks associated with Coronary artery bypass surgery -
Myocardial Infarction.
Acute Renal failure.
Stroke.
Pneumothorax.
Hemothorax.
uPericardial Tamponade.
Pleural Effusion.
 
Cardiac Shockwaves Therapy (CSWT)
 
 
What is CSWT ?
The acronym CSWT stands for Cardiac shock wave therapy. CSWT is a new non-invasive therapy approach using Extracoporeal Shockwave technology for Myocardial Revascularization (i. e. to improve the blood supply to heart muscles). Ischemic myocardial areas no longer accessible by conventional revascularization therapies like Bypass surgery or Ballon Angioplasty and Stent, could be treated with CSWT to relieve symptoms resulted from the myocardial  ischemia.
 
Why CSWT ?
Patients with advanced CAD frequently have recurrent Angina. Surgical and interventional options for these patients typically have been exhausted or will result in only partial revascularization. CSWT offers new hope for these patients and provides therapy which complement existing treatment procedures.
 
How is CSWT performed ?
The treatment is performed using shock wave generator that is designed to address the unique clinical-anatomical requirements of the chest cavity. A cardiac ultrasound imaging system is used to locate the treatment area and to map the exact position and extent of the ischemic zone. Shock waves are then delivered via the anatomical acoustic window to the treatment area under E. C. G. R-wave gating. Several treatment sessions are required to obtain optimal results.
 
How does CSWT work ?
CSWT produces new pathways around the blocked arteries in the ischemic zone of the heart. It does this by expanding networks of tiny blood vessels called collaterals. New natural blood vessels are formed, which improve the supply of oxygenated blood to the affected portion of the heart through a process called angiogenesis, thereby reducing or relieving angina. Angiogenesis can be considered to be a form of natural bypass.
 
What is the therapeutic effect of shockwaves on the heart ?
The therapeutic effect of shock waves is attributed to the mechanical pressure and tension that the acoustic wave exerts on the cardiac tissue. Delivery of low intensity shockwaves causes sheer stress on the vessel wall. This stimulates angiogenesis related growth factors-(eNOS, VEGF and PCNA) initiating the angiogenesis process.
 
What is Angiogenesis ?
Angiogenesis or Neo-vascularization means formation or growth of new blood vessels (otherwise called coronary collateral formation) naturally; which in turn increases the blood supply to the ischemic area of the heart and improves the myocardial perfusion. Hence, coronary collateral angiogenesis can also be called NATURAL BYPASS.
 
 

Angiogenesis by mobilization of EPCs (Endothelial Precursor Cells) from the bone marrow and from the pre-existing vessels (capillary growth).

In angiogenesis from pre-existing vessels, endothelial cells from these vessels become motile and proliferate to form capillary sprouts. Regardless of the initiating mechanism, vessel maturation (stabilization) involves the recruitment of pericytes and smooth muscle cells to form the peri-endothelial layer.

 
 
EPCs are mobilized from the bone marrow and may migrate to a site of injury or tumour growth. At these sites, EPCs differentiate and form a mature network by linking to existing vessels.
 
 
Who are the candidates for CSWT ?
Chronic chest pain (Refractory Angina) even after Bypass Surgery or Angioplasty.
Having 70%-100% blockages in angiogram.
Reblocks after bypass surgery or Angioplasty.
Chronic Renal disease with heart attack problem.
High risk cases medically unfit for BYPASS SURGERY.
Patient’s coronary anatomy not readily amenable for Bypass surgery.
Inability to perform angioplasty because the target lesion is inaccessible.
Patient is not willing for surgical procedures.
 
What is the purpose of CSWT ?
The purpose of this innovative non-surgical treatment is to produce new pathways around the blocked arteries in ischemic zone of the heart by expanding networks of tiny blood vessels called collaterals that help increase and normalize the blood flow to heart muscle thereby reducing or relieving angina.
 
Why CSWT is called Non-Invasive or Non-Surgical Bypass treatment ?
CSWT forms new natural blood vessels which improves the oxygenated blood supply to the affected portion of the heart non-surgically or non-pharmaceutically. For the reason it is called Non-invasive or Non-Surgical Bypass treatment or Non-Invasive Cardiac Angiogenesis therapy (Ni-CATh).
 
What is treatment duration and strategy ?
The whole treatment duration is 20-30 minutes and the patients should undergo a series of nine treatment sessions during a nine week period. (3 treatments at first week of each month – 1st week, 5th week, 9th week) At each treatment session shockwaves are delivered to the border of the ischemic area.
 
How would you feel during CSWT ?
During the treatment you might feel a local tickling in the treatment area, accompanied by a certain degree of noise.
 
Is shockwave technology used in other fields of medicine ?
Shockwave technology is presently being used in the field of Urology for breaking kidney stones and in Orthopedics for bone and soft issue injuries.
 
What are the distinct advantages of CSWT over surgery ?
Unlike Bypass surgery, Angioplasty and stenting procedures, CSWT is non-invasive, carries no risk, painless, no anaesthesia or sedatives required, no re-treatment limitations and is an outpatient procedure.
 
What are the risks or side effects of CSWT ?
No acute or long term side effects were reported.
 
How do you know the treatment has helped ?
Patient can walk more distance without chest pain.
Patient would have fewer or no angina.
Episodes of angina will be less painful.
Patient need for anti-angina medications can be reduced.
Patient can return to work and can participate in their active lifestyle once again.
Patient would be more energetic and confident.
Shockwave therapy is the optimal therapy approach for Ischemic Heart Disease.
 
Who developed the concept of CSWT ?
CSWT was developed by Essen Institute of Cardiology, Essen University, Germany.
 
Shock Waves applied to ischemic heart tissue (CSWT)
 
 
CSWT Treatment Results
 
 
Number of Visible Coronary Arteries
 
 
 
 
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