Extracorporeal Shockwave Myocardial Revascularization (ESMR)

Extracorporeal Shockwave Myocardial Revascularization abbreviated as ESMR has become one of the successful methodologies of non invasive treatments for improving the blood supply to the heart muscles. Also known as Non invasive Cardiac Angiogenesis Therapy (Ni-CATh), ESMR treatment in India is fast gaining popularity as a dependable heart treatment without angioplasty, bypass surgery. For the benefit of patients who would like to avoid angioplasty, bypass surgery, Poona Preventive Cardiology Center (PPCC) has introduced this German concept in their clinic.


Why ESMR and how it works

ESMR is a non invasive treatment and the huge advantage of ESMR lies in the fact that it can be successfully deployed to treat the symptoms of Ischemic myocardial areas that cannot be accessed otherwise by other therapies such as Bypass or Angioplasty. The main reason behind deploying ESMR in treatment can be either due to exhaustion of all other avenues or the possibility of achieving only partial results through conventional procedures. Nevertheless, ESMR offers new ray of hope that complements the existing treatment methodologies.

Prior to the commencement of the procedure, the exact location of the ischemic zone (treatment zone) is identified using the ultrasound imaging system. As the name of the treatment suggests, shockwaves that are mild in nature are targeted to the treatment zone through the anatomical acoustic window. These acoustic waves create shear stress on the vessel wall and stimulate growth of new blood vessels and expand their network around the blocked arteries, which in turn enhances the quantum of blood supply to the heart and reduces the occurrences of angina.

Am I a candidate for Treatment?

  • Patients who like to avoid invasive procedures
  • Treatment of target location not accessible through conventional procedures
  • Medical cases not favorable for bypass surgery
  • Chronic chest pain or re-blocks even after conventional treatment methodologies
  • Chronic renal diseases and associated with heart attacks.
  • Severe blockages detected in angiogram

Treatment Duration

After conducting the preliminary tests and screening procedures and ascertaining the suitability of the candidature, the treatment sessions are initiated. Typically each session lasts for half an hour and the total treatment lasts for nine sessions that is spread across a period of three months.

Side effects

During the treatment procedure, no pain more than a tickling effect is felt. It does not carry any associated risk factors. Being an outpatient and non-invasive procedure, sedatives are also not required. In short, no short term or long term side effects are reported till now.


  • It can be employed for treatment where it is not possible through bypass surgeries or angioplasty.
  • Absolutely painless
  • The patients can again be treated if necessary without any restrictions.


It is pretty easy to measure the success of ESMR through qualitative techniques. The patient would be more energetic and indulge in active life style as before. He would also experience nil or only few episodes of angina with less pain.

In a nutshell, ESMR offers new ray of hope for the heart patients who are deprived of other chances due to various reasons that include medical conditions.