Dr. Manish Ganwani, interventional cardiologist, Nagpur
Nagpur. Coronary artery disease (CAD), a narrowing of the heart’s coronary arteries due to severe blockages in the form of plaque, is one of the most common heart diseases. The mortality rate in this disease ranges from 10 to 25 percent. Plaque is made up of cholesterol, fat, and waste cells from our blood. It is caused due to irregular routine and eating habits.
If coronary artery disease is not treated, it can completely block blood flow, increasing the risk of heart attack or heart failure. When the blockage is less than it can be cured with some medicines and regular routine changes. If the blockage is severe, the patient may require angioplasty or surgical intervention. Thousands of angioplasties and bypass surgeries are performed every year. Now the use of advanced procedures of cardiac science has enabled patients to choose appropriate treatment options such as medical therapy or the right decision regarding coronary angioplasty or bypass surgery. It helps to take State-of-the-art tests to help interventional cardiologists to decide whether to use new techniques such as rotablation and shock wave therapy before stenting.
New technologies in imaging and physiology with coronary intervention —
IVUS: Intra vascular Ultrasound —
This technique is similar to endoscopy. In this technique a wire is inserted into the patient’s artery on which the camera is mounted. This helps to see the blockage. This technique shows the narrowing of the artery, the length and stiffness of the blockage, and the calcium stored in the artery. Not only this, after stenting the patient whether the implantation is correct or not, it can also be known by this technique. IVUS involves the use of a transducer to generate sound waves that strike the walls of the arteries and convert the resulting echo into the picture.
OCT: optical Coherence Tomography —
OCT is an optical imaging technique that uses infrared light to visualize the inside of blood vessels and determine the type and extent of plaque. Along with this, it also gives an accurate assessment of the size, expansion and correct opening of the stent.
New techniques are more effective and result-oriented in coronary artery disease and help the patient decide on the best option between medical therapy, angioplasty or bypass surgery.
Rota – Rotablation Angioplasty –
Rota uses a special catheter with Acom shaped diamond-coated tip that drills a narrowed coronary artery with calcium. The tip of the catheter spins rapidly and breaks up the calcified plaque on the walls of the coronary artery into fine pieces. This technique is used in cases where the plaque is either high in calcium or the arteries are too narrow. Rotablation is used in calcified and complicated coronary arteries that require safe stenting without coronary artery bypass surgery. The risk of angiographic restenosis and revascularization (in case of stenting failure) is also greatly reduced by the use of Rota compared to coronary intervention of other catheters in these same cases.
Intravascular Lithotripsy (Shockwave Therapy)
Shockwave intravascular lithotripsy (IVL) is a novel device used in patients with calcified blockages. It is a new option for the treatment of calcified blockages in which interventional cardiologists can correct severe blockages without any complications with conventional instruments. Shockwave Medical Coronary IVL Catheter is a single use disposable catheter that is connected to an integrated balloon and fitted with multiple lithotripsy machines. This machine creates a sonic pressure wave for the affected area. This sonic pressure wave breaks down calcium, creating space in the artery, thus correcting the accumulation of plaque on the artery walls.
OPN NC balloon: OPN NC is a twin-layer device for treating in-stent restenosis, severely calcified lesions, and other challenging lesions. Ultra-high pressures are used by OPN NC to fracture calcium or oppose calcium to the artery wall.
Polymer free Stent: The new generation stents are made of cobalt chromium metal instead of polymer. These are also drug eluting stents that release 80 percent of the drug within 28 days of implantation and in these stents, a drug called “Probucol” has been used, which will act as a polymer but will not cause problems like that.
Newer metal stents are more visible after implantation in imaging guided angioplasty such as OCT or IVUS and are more flexible than earlier polymers. New generation stents are very beneficial for diabetic patients, who are prone to re-stenosis. This new generation stent is safer and carries much better results post angioplasty. It has 10 years of data on all research and development.