COMPLEX PERCUTANEOUS CORONARY INTERVENTION (PCI)
Percutaneous coronary intervention (PCI) universally known as coronary Angioplasty or just Angioplasty is a non-surgical procedure used for the treatment of the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the accumulation of the cholesterol-laden plaques that form due to atherosclerosis. PCI is typically carried out by an interventional cardiologist, while it was developed and formerly performed by interventional radiologists.
BIFURCATION STENTING TREATMENT
Procedure:
An advanced (dedicated bifurcation stent) is used, which is shaped in such a way to remove narrowing from both the branches and has to be inserted through two wires to place it simultaneously in both branches. Stent covers both branches and is drug coated.
Major Indications:
Bifurcation lesion means there is a blockage in a site where the blood vessel divides into two and is more challenging to treat. Two branches of the blood vessel have a narrowing.
BIORESORBABLE VASCULAR SCAFFOLD
Procedure:
A non metallic mesh tube that is used to treat a narrowed artery, is similar to a stent, but slowly dissolves once the blocked artery can function naturally again
Major Indications:
Bioresorbable Vascular Scaffold is a non-metallic, non-permanent, mesh implant which gets absorbed gradually, dissolves over time and allows the artery to function naturally again.
INTRA-AORTIC BALLOON PUMP (IABP) IN INDORE
Procedure:
The Intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing Cardiac output. It consists of a cylindrical polyethylene balloon that sits in the aorta and counterpulsates. That is, it actively deflates in systole, increasing forward blood flow by reducing afterload through a vacuum effect. It actively inflates in diastole, increasing blood flow to the coronary arteries via retrograde flow.
Major Indications:
- Reversible intracardial mechanical defects complicating infarction, i.e. acute mitral regurgitation and septal perforation.
- Unstable angina pectoris benefits from counterpulsation.
- Post Cardiothoracic surgery – most common and useful is counterpulsation in weaning patients from cardiopulmonary bypass after continued perioperative injury to myocardial tissue.
- Preoperative use is suggested for high-risk patients such as those with unstable angina with stenosis greater than 70% of main coronary artery, in ventricular dysfunction with an ejection fraction less than 35%.
- Percutaneous coronary Angioplasty.
- In high risk coronary artery bypass graft surgery where cardiopulmonary bypass time was shortened, as well as during intubation period and hospital stay.
- Thrombolytic therapy of acute myocardial infarction.
FRACTIONAL FLOW RESERVE (FFR) MEASUREMENT IN INDORE
Procedure:
Fractional flow reserve (FFR) measurement involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery. An FFR of 1.0 is widely accepted as normal. An FFR lower than 0.75-0.80 is generally considered to be associated with myocardial ischemia (MI).
FFR is easily measured during routine coronary angiography by using a pressure wire to calculate the ratio between coronary pressure distal to a coronary artery stenosis and aortic pressure under conditions of maximum myocardial hyperemia.
Major Indications:
- To determine the physiologic and hemodynamic significance of an angiographically intermediate coronary stenosis.
- To identify appropriate culprit lesion(s) in multi-vessel coronary artery disease (CAD).
- To measure the functional importance of stenosis in the presence of distal collateral flow.
- To identify the precise location of a coronary lesion when the angiographic image is unclear.
TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) OR TAVR IN INDORE
Procedure:
TAVR valves are inserted via a catheter through the femoral artery, without requiring open heart surgery.
Major Indications:
Transcatheter Aortic Valve Implantation TAVI or TAVR is a procedure for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for traditional open chest surgery or are high-risk operable candidates.
ATHERECTOMY HOSPITALS
Procedure:
Similar to Angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.
Major Indications:
- Increases blood flow through the blocked artery by removing plaque buildup.
- May also be used in carotid arteries (major arteries of the neck leading to the brain) to remove plaque and reduce risk for stroke.
