Procedure of Coronary Angioplasty
An angiogram is performed prior to angioplasty. Here, a thin plastic tube is inserted into an artery in the groin or arm. A long, narrow, hollow tube, called a catheter, is passed through the sheath and guided up the blood vessels to the arteries surrounding the heart. A small amount of contrast liquid is injected through the catheter and is photographed with an X-ray as it moves through the heart’s chambers, valves, and major vessels. From the digital pictures of the contrast material, one can find out whether the coronary arteries are narrowed.
Dr. Gaurav Ganeshwala pioneered the radial angiogram procedures in India leading to daycare procedures with same-day discharge. Angiogram procedure takes less than 10 minutes and is done under local anesthesia.
A thin, flexible tube called a catheter is inserted into an artery and fed to the site of a blockage within the blood vessel. The interventional cardiologist opens a tiny balloon at the end of the catheter to push aside the blockage, improving blood flow through the artery.
A stent is a small tube that acts as a scaffold to provide support inside the coronary artery. Starting from stainless steel stents, they have evolved now into thinner cobalt-chromium or platinum chromium stents. Atherectomy devices are used to debulk highly calcified lesions.
A catheter is used to deliver the stent into the narrowed coronary artery. Once in place, the balloon tip is inflated and the stent expands to the size of the artery and holds it open. Innovations in catheters have been ranging from the original balloon catheter to more flexible and soft ones.
The ClearWay™ RX – Rapid Exchange Therapeutic Perfusion Catheter helps save larger areas of the heart muscle in heart attacks.
The CrossBoss Catheter is the latest technology for the treatment of chronic and 100% blocked arteries. A decade ago, most of the patients with 100% blocked arteries were either managed medically or sent for surgery. This catheter facilitates the crossing of the 100% block, either through the tough lesions or can travel behind the blocked segment and exit beyond the lesion. The Stingray Balloon is used to get back into the actual passage of the blood vessel, using specialized wires.
Rotablation represents an addition to the standard PTCA procedure. While a standard PTCA procedure is limited to the use of balloons and stents, rotablation also uses a tiny drill, powered by compressed air, to remove calcified deposits.
Percutaneous rotational coronary angioplasty as a sole therapy or with adjunctive balloon angioplasty is indicated in patients with coronary artery disease who are acceptable candidates for coronary artery bypass graft surgery and who meet one of the following selection criteria:
- Single vessel atherosclerotic coronary artery disease with a stenosis that can be passed with a guidewire;
- Multiple vessel coronary artery disease that in the physician’s judgment does not pose undue risk to the patient;
- Certain patients who have had prior percutaneous transluminal coronary angioplasty (PTCA), and who have restenosis of the native vessel; or,
- Native vessel atherosclerotic coronary artery disease that is less than 25 mm in length.
Dr. Gaurav Ganeshwala
Ruby Hall Clinic, Pune