Coronary Artery Disease

1. CORONARY ANGIOGRAM

A Coronary Angiogram is a medical imaging test that visualizes the coronary arteries, which supply blood to the heart.

What it shows

1. Identifies stenosis (narrowing) or blockages in the coronary arteries.

2. Provides detailed images of the coronary artery.

How it’s done

1. A catheter is inserted into an artery in the groin or forearm.

2. A contrast dye is injected through the catheter.

3. X-ray images are taken to visualize the coronary arteries.

Purpose

1. Diagnose coronary artery disease.

2. In planning angioplasty, stenting or other treatments.

2. CT Coronary Angiogram

A CT Coronary Angiogram is a non-invasive imaging test that uses computed tomography (CT) technology to visualize the coronary arteries.

What it shows:

– Detailed images of the coronary arteries.

– Helps identify stenosis (narrowing) or blockages.

– Can detect plaque buildup (atherosclerosis).

How it’s done:

– CT scan is taken after injecting dye into vein.

– This helps capturing coronary artery images in detail.

Benefits:

– Accurate diagnosis: Helps diagnose coronary artery disease.

– Non-invasive: No need for hospitalization or surgical incisions.

– Guiding treatment: Helps guide treatment decisions, such as angioplasty or stenting.

3. CT Coronary Calcium score

A CT Coronary Calcium Score is a non-invasive test that measures the amount of calcium in the coronary arteries.

What does it detect?

1. Calcium deposits: The test detects calcium buildup in the coronary arteries, which can indicate plaque buildup and atherosclerosis.

2. Cardiovascular risk: The score helps assess an individual’s risk of developing coronary artery disease.

How is it done?

1. CT scan: A computed tomography (CT) scan is used to image the coronary arteries.

2. Calcium scoring: The amount of calcium is measured and scored by a dedicated software.

What does the score mean?

1. Low risk: A score of 0 indicates no detectable calcium and a low risk of heart disease.

2. Moderate to high risk: Higher scores indicate more extensive calcium buildup and a higher risk of heart disease.

Benefits:

1. Does not require dye injection and uses very low radiation. 

2. Early detection: Helps identify individuals at risk of coronary artery disease.

3. Risk stratification: Guides preventive measures and treatment decisions.

4. Fraction Flow Reserve (FFR)

FFR stands for Fractional Flow Reserve in cardiology. It’s a technique used to measure the pressure difference across a coronary artery blockage.

What does FFR measure?

1. Pressure readings are taken before and after the blockage.

2. FFR calculates the ratio of these pressures.

What does FFR indicate?

1. Significance of blockage: FFR helps determine if a blockage is significant enough to limit blood flow.

2. Need for intervention: FFR guides decisions about stenting or other treatments.

Benefits:

1. Accurate assessment: FFR provides a precise measurement of blockage severity.

2. Personalized treatment: FFR helps tailor treatment to individual patient needs.

When is FFR used?

1. Intermediate blockages: FFR helps determine the best course of action.

2. Complex cases: FFR provides valuable insights in challenging diagnostic situations.

FFR is a valuable tool in cardiology, enabling healthcare providers to make informed decisions about coronary artery disease treatment.

5. Balloon Angioplasty

Balloon Angioplasty is a minimally invasive procedure used to widen narrowed or blocked coronary arteries.

How it Works:

1. A small balloon catheter is inserted into the narrowed artery.

2. The balloon inflates, compressing the plaque and widening the artery.

3. The balloon then deflates and is removed, leaving the artery open.

Benefits:

1. Restores Blood Flow: Improves blood flow to the heart muscle.

2. Relieves Symptoms: Reduces chest pain (angina) and shortness of breath.

When is it Used?

1. Coronary Artery Disease: To treat narrowed or blocked coronary arteries.

2. Acute Coronary Syndrome: In emergency situations, such as a heart attack.

Balloon Angioplasty is often used in combination with stenting to keep the artery open.

6. PCI with Drug eluting stenting (Coronary stents)

What is Drug-Eluting Stenting (DES)

1. A small, mesh-like stent is placed in the narrowed coronary artery.

2. The stent is coated with a medication (e.g., sirolimus, Zotarolimus or everolimus) that slowly releases over time.

3. The medication helps prevent restenosis (re-narrowing) by inhibiting cell growth.

Benefits

Helps artery from re narrowing & Improve blood flow to heart.

7. PCI with Drug coated balloon 

A Drug-Coated Balloon (DCB) is a type of Coronary injection. Which does not use stent for treatment of blockages.

1. Procedure

1. A small balloon catheter is inserted into the narrowed coronary artery.
2. The balloon is coated with a medication (e.g., paclitaxel) that helps prevent restenosis (re-narrowing).
3. The balloon inflates, opening the artery and delivering the medication.

2. When is DCB used

1. In-stent restenosis: When a previously placed stent becomes narrowed.
2. Small vessel disease: When the affected artery is too small for a stent.

3. Benefits

DCB is a valuable treatment option in PCI, offering a metal-free alternative for certain patients.

8. 24X7 PRIMARY ANGIOPLASTY FACILITY FOR ACUTE CORONARY SYNDROME 

A 24×7 Emergency Angioplasty Facility for Acute Coronary Syndrome (ACS) is a hospital’s dedicated service that provides immediate, around-the-clock angioplasty procedures for patients experiencing a major heart attack.

What it Offers

– Immediate Angioplasty: A minimally invasive procedure to open blocked coronary arteries and restore blood flow to the heart.

– Round-the-Clock Availability – Expert Care: A team of skilled cardiologists, nurses, and support staff are available to provide timely and effective treatment.

Benefits

1. 1. Life-Saving: Emergency angioplasty can be a lifesaving procedure for heart attack patients.
   2. Time-Critical: Prompt treatment is essential to minimize damage and improve outcomes.
   3. Time is muscle: Earlier a primary angioplasty is done, better the outcomes.

9. COMPLEX CORONARY INTERVENTIONS

Angioplasty procedures that involve more difficult or challenging conditions.

1. Chronic total occlusions (CTOs): Complete blockages that have been present for a long time.
2. Severely calcified arteries: Hardened plaques with high calcium deposition are resistant to treatment.
3. Bifurcation lesions: Blockages occurring at the branching points of arteries.
4. Left main coronary artery disease: Blockages in the left main artery, which supplies approximate 70% of the heart.
5. High-risk patients: Individuals with comorbidities, such as diabetes or kidney disease, or who have had previous heart surgeries.
6. May require advanced investigation techniques (IVUS/OCT/FFR).
7. Advanced techniques to optimize outcomes of angioplasty. 
8. Rotablation
9. IVL 

10. DIAGNOSTIC MODALITIES USED IN COMPLEX CORONARY INTERVENTION

1. IVUS

IVUS stands for Intravascular Ultrasound in cardiology. It’s a medical imaging technique that uses high-frequency sound waves to visualize the coronary arteries from within.

How IVUS Works

1. A small catheter with an ultrasound probe is inserted into the coronary artery.

2. The probe emits high-frequency sound waves, which reflect off the artery walls.

3. The reflected sound waves are used to create detailed, cross-sectional images of the artery.

IVUS is used for

1. Coronary artery disease diagnosis: To assess plaque buildup and artery narrowing.

2. Stent placement guidance: To ensure optimal stent deployment.

3. Follow-up imaging: To monitor stent patency and detect potential issues.

2. OCT

• OCT stands for Optical Coherence Tomography in uses infra-red light to visualize the coronary arteries.

How OCT Works

1. A thin, flexible catheter with an optical probe is inserted into the coronary artery.

2. The probe emits near-infrared light, which reflects off the artery walls.

3. The reflected light is used to create high-resolution, cross-sectional images of the artery.

OCT is used for

1. Coronary artery disease diagnosis: To assess plaque buildup and artery narrowing.

2. Stent placement guidance: To ensure optimal stent deployment and reduce complications.

3. Follow-up imaging: To monitor stent patency and detect potential issues.

11. MODALITIES / DEVICES USEFULL IN COMPLEX CASES

1. ROTABLATION

Rotablation is a minimally invasive procedure in cardiology used to treat calcified coronary artery lesions. It involves using a high-speed rotational burr, typically diamond-coated, to grind and pulverize calcified plaque buildup in the arteries. This process restores blood flow to the heart, preventing further damage.

How Rotablation Works    (+ add video)

• • A specialized catheter with a diamond-coated burr is threaded through the coronary arteries to the site of calcification.
  • The burr rotates at high speeds, grinding the calcified plaque into tiny particles that are then safely carried away by the bloodstream.
  • After rotablation, a balloon catheter is often used to widen the artery, and a stent may be placed to keep the artery open.

 When is Rotablation Recommended

For patients with severe coronary artery blockages, especially those with heavily calcified arteries.

Benefits of Rotablation

• • Precision and Selectivity: Targets calcified areas specifically, minimizing damage to healthy vessel walls.
  • Enhanced Procedural Success: Effective in cases where traditional interventions might fail.

2. IVL

IVL stands for Intravascular Lithotripsy in cardiology. It’s a novel technology used to treat calcified coronary artery lesions.

How IVL Works      (+add video)

1. A specialized balloon catheter is used to deliver sonic pressure waves to the calcified lesion.

2. These shockwaves break up the calcium deposits, making it easier to treat the lesion.

3. After IVL, a stent is typically placed to keep the artery open.

Benefits of IVL

1. Effective in treating calcified lesions that are difficult to treat with traditional methods.

2. Reduces the risk of complications during stent placement.

IVL is used for

1. Calcified coronary artery disease.

2. Lesions that are resistant to traditional angioplasty.

IVL is a valuable tool in interventional cardiology, offering a new approach to managing complex coronary artery disease.

3. Orbital atherectomy  

Orbital atherectomy is a minimally invasive procedure that uses a small, diamond-coated.

The device works by orbiting (rotating) at high speed, sanding away the plaque, and helping to restore healthy blood flow.

Device to

Remove calcified plaque buildup in arteries

12. HEMODYNAMICALLY UNSTABLE PATIENTS

Patients who may require mechanical support devices for PCI

1. Patient on ventilator

2. Low BP (Hypotension)

3. UNSTABLE PATIENTS

4. Complex CAD

13. MECHANICAL SUPPORT DEVICES

1. IABP   

IABP stands for Intra-Aortic Balloon Pump.

What it does:

Increases blood flow: Enhances blood flow to the coronary arteries and other vital organs.

How it works:

 Inflation and deflation: A balloon inflates and deflates in sync with the heartbeat.

Uses:

1. Cardiogenic shock: Supports patients with heart failure or cardiac arrest.

2. High-risk cardiac procedures: Used during procedures like angioplasty or cardiac surgery.

The IABP is a mechanical support device that helps stabilize patients with severe cardiac conditions.