Shockwave Therapy in Atherosclerosis

The medical use of high energy extracorporeal shockwaves started in the 1980’s, when they were targeted to fragment urinary stones (lithotripsy, ESWL) and gallstones [1,2]. In addition ESWT has been used in orthopedics for musculoskeletal disorders, wound and non-union healing of fractures and the stimulation of bone growth [3-8]. The exact mechanism of action of ESWT on soft tissue is not fully understood, although the principle of mechano transduction is thought to be responsible for the biological changes that take place, Mechano transduction transfers mechanical stimuli into chemical signals at the cellular level, which activates gene expression of growth factors and cytokines as well as cell proliferation and differentiation [9]. Increased expression of growth factors such as endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factors (VGEFs) in soft tissue has been observed in animal studies [10-13]. Due to these findings further applications of ESWT are explored such as in atherosclerosis. One such application included the use of ESWT in ischaemic heart disease and in claudication in peripheral arterial disease. In this mini-review the recent developments in the application of ESWT in the field of atherosclerosis are discussed.