Impella is a medical device used to provide temporary mechanical circulatory support for patients with severe heart conditions. It is specifically designed to assist the heart's pumping function and improve blood flow in situations where the heart is unable to pump enough blood on its own. The Impella device is known as a percutaneous ventricular assist device (PVAD) because it is inserted into the heart through a minimally invasive procedure without the need for open-heart surgery.

The Impella device consists of a catheter with a tiny motor-driven pump at the tip. It is typically inserted through the femoral artery in the groin and guided into the left ventricle, which is the main pumping chamber of the heart. Once in place, the pump is activated, and it draws blood from the left ventricle into the device and then expels it into the aorta, the main artery that carries oxygenated blood to the rest of the body. This helps to increase the heart's output and improve blood flow to vital organs and tissues.

Coronary shockwave refers to a medical procedure known as Intravascular Lithotripsy (IVL) or coronary lithotripsy. It is a novel technique used during percutaneous coronary intervention (PCI) to treat heavily calcified coronary artery lesions.

When a coronary artery becomes severely narrowed or blocked due to atherosclerosis (a buildup of plaque, cholesterol, and calcium), it can lead to reduced blood flow and potentially cause angina (chest pain) or even a heart attack. Conventional balloon angioplasty and stent placement may not be as effective in these heavily calcified lesions because the hardened calcium can be resistant to compression.

Intravascular lithotripsy, also called coronary shockwave therapy, involves the use of a specialized catheter with an integrated lithotripsy balloon at its tip. This balloon emits sonic pressure waves (shockwaves) that safely break up the calcified plaque while minimizing damage to the surrounding arterial tissue. This process is similar to lithotripsy used to break kidney stones.

Atherectomy is a medical procedure used to treat atherosclerosis, a condition where plaque builds up inside the arteries, leading to reduced blood flow. During the procedure, a special device called an atherectomy catheter is used to remove or modify the plaque deposits from the artery walls.

The atherectomy catheter typically has a cutting or ablating mechanism that can break down or remove the plaque, allowing the artery to open up and restore better blood flow. This procedure is often performed on arteries in various parts of the body, such as the heart (coronary arteries), legs (peripheral arteries), and neck (carotid arteries).

Atherectomy is considered an alternative to other treatments for atherosclerosis, such as angioplasty and stent placement. In angioplasty, a balloon-tipped catheter is used to compress the plaque against the artery walls to widen the artery. Sometimes, a stent (a small mesh tube) is placed in the artery to keep it open. However, in certain cases, atherectomy may be preferred, especially if the plaque is too hard or calcified to be easily treated with angioplasty alone.