08 COVER STORY
The HEALTH | March-April. 2026
Sounding out stiff plaque
• Hardened, calcified plaque makes heart artery disease significantly harder to treat than softer blockages.
• Intravascular lithotripsy introduces a new approach, using sonic waves to break down hard plaque from within the artery.
• IJN pioneers IVL in Malaysia, marking a significant milestone in advancing local cardiac care.
FOR many people, a heart condition begins quietly: plaque. Over time, cholesterol, fats and calcium accumulate along artery walls, narrowing the vessel and limiting blood flow. This progression is referred to as atherosclerosis, and in its most severe form, it becomes far harder to treat.
When plaque hardens and calcifies, the usual approach to reopening arteries can be a struggle. Balloons may inflate, but the lesion may not yield. Stents may deploy, yet results may be less reliable when the blockage remains rock-like.
In February 2021, Institut Jantung Negara( IJN) described intravascular lithotripsy( IVL) as a newer, safer option for patients with severe atherosclerosis. The hospital states that IVL is FDA-approved, uses sonic waves to break down hard calcified plaque, and has been performed successfully at IJN.
IJN frames IVL as a targeted way to address a particularly stubborn cause of arterial nar-
" When the plaque has hardened to that extent, patients may have to undergo an invasive surgical procedure to treat the condition, where doctors have to surgically remove the plaque or even perform a graft bypass to ensure good blood flow." rowing: hard, calcified plaque.
- Dato’ Dr Amin Ariff Nuruddin
NOT ALL PLAQUE IS EQUAL
Atherosclerosis is a condition in which cholesterol, fats and calcium deposits build up into plaque within the arteries. As plaque accumulates, it narrows the vessel lumen and restricts blood flow.
When atherosclerosis is identified early, it can often be managed with lifestyle changes and medication to slow disease progression and, in some cases, reduce plaque build-up.
But when blockages become more serious, treatment commonly shifts towards angioplasty and stent placement. In this approach, a catheter( a thin, flexible tube) delivers a small balloon to the site of narrowing through the blood vessels.
The balloon inflates to expand the artery and press plaque aside. A stent( a small mesh tube) is then placed to help keep the artery open for improved blood flow.
This strategy works best when plaque is softer and more responsive to balloon expansion. But once plaque has hardened and calcified, angioplasty may be less effective.
IJN Senior Consultant Cardiologist Dato’ Dr Amin Ariff Nuruddin explained:“ When the plaque has hardened to that extent, patients may have to undergo an invasive surgical procedure to treat the condition, where doctors have to surgically remove the plaque or even perform a graft bypass to ensure good blood flow.”
These options carry greater procedural intensity than catheter-based treatment. IJN therefore presents IVL as a minimally invasive pathway that helps reduce the need to move directly to surgery in appropriate severe calcified cases.
BREAKING PLAQUE WITH SOUND
IVL follows a familiar catheter-based approach, using a balloon catheter that is delivered to the blocked segment in a manner similar to angioplasty.