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Extracorporeal Shockwave Myocardial Revascularisation (ESMR)

Rays that heal the heart

What is ESMR?

Extracorporeal Shockwave Myocardial Revascularisation (ESMR) is the latest non-invasive FDA (USA) approved therapy approach using shockwave technology to improve the blood supply to the heart by forming new natural blood vessels around blockages relieving chest pain for a long time in patients suffering from Coronary Artery Disease (CAD). Ischemic myocardial areas no longer accessible by conventional revascularisation

therapies like Bypass surgery or Balloon Angioplasty and Stent, could be treated with ESMR therapy to relieve symptoms. Hence, it is also known as Non-Surgical Bypass or Non-Invasive Cardiac Angiogenesis Therapy (Ni-CATh). 

ESMR therapy offers new hope to patients with advanced CAD, patients who have recurrent Angina, patients who have exhausted other surgical and interventional options.Unlike Bypass surgery, Angioplasty and Stenting procedures, ESMR is non-invasive, carries no risk, painless, no anaesthesia or sedatives required, no re-treatment limitations and is an outpatient procedure.

How it works?

ESMR is an outpatient procedure completed over 9 half hour sessions performed on alternate days. The doctor identifies the ischemic regions using Ultrasound Imaging and identifies where the shock-waves have to be focused. The patient lies on a table and is connected to the ECG of the ESMR. Low energy sound waves are then focused non-invasively by a unique applicator. Some patients report a tickling sensation on their chest in a few minutes. When the treatment is concluded, the patient can go back to work.

ESMR produces new pathways around the blocked arteries in ischemic zones of the heart by expanding networks of tiny blood vessels called collaterals that help increase and normalise the blood flow to heart muscle thereby reducing or relieving angina.

Who should have ESMR?

  • Patients suffering from Coronary Artery Disease (CAD)

  • Patients with chronic chest pain (Refractory Angina)

  • Patients who have previously had bypass surgery to unsatisfactory or failed results

  • Patients who have previously had angioplasty to unsatisfactory or failed results

  • High risk patients, unfit for bypass

  • Patients requiring post-bypass cardiac rehabilitation

  • Patients with difficult to treat small vessel disease

  • Patients experiencing re-blocks after bypass surgery or angioplasty

  • Patients experiencing chronic renal disease along with heart problems

  • Patients not willing for surgical intervention

Benefits of ESMR

  • Non-invasive

  • Affordable

  • No anaesthesia required

  • Improved oxygen uptake

  • Increased physical exercise capacity

  • Short treatment time

  • No long term recovery period

  • Usually no hospital stay required

  • Reduction of medicines for chest pain

  • Increased blood flow at the treated area

  • No acute or long-term side-effects

  • Compliments ongoing therapies

How does the patient know he has improved?

Patients experience improvement in their quality of life. They feel better, test better, have less frequency and intensity of chest pains, breath better, can walk longer distance and require less medication. They have increased energy and work capacity, memory, mental ability, sexual performance, less fatigue, lesser leg pains and improved general look and skin colour. Improvements can also be assessed scientifically with Cardiovascular Cartography (CCG) or Stress Thallium as they document the blood flow. Angiography assesses the patency and stenosis in three big blood vessels and their major branches but is not suitable for visualizing the millions of smaller blood vessels and capillaries, nor for assessing the overall blood flow to the heart muscle which is what ultimately matters.

Safety of ESMR

ESMR is non-invasive and, in the case of musculoskeletal diseases, can be performed without the risks associated with surgical procedures. Additionally, the rate of complications resulting from ESW therapy is considered negligible, with no reports of arrhythmias, heart failure, syncope, palpitations, breathing difficulty, bleeding, embolism, shock, or troponin.

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