There have been several developments in the medical technology in terms of the heart and all these developments can be similar to how stethoscope gives information on heart sounds. The Cath lab or Catheterisation Laboratory is an extremely particular, futuristic section inside large hospitals, within the departments of Cardiology. Doctors bring in patients over here, to look into and closely listen to what the heart says.
I am a senior Interventional Cardiologist at Apollo Hospitals, Chennai, and I insist on the utility of the cath lab. The cath lab has allowed me to comprehend, and change the way we treat. Inside the cath lab, blocks within the heart blood vessels are detected and removed using technologies including Fractional Flow Reserve, Intra-vascular Ultra Sound, and Optical Coherence Tomography. These technologies permits doctors like me to visualise inside the arteries. In fact, it helps us to precisely locate the place, duration, and degree of stenosis – the blockages created due to deposits and the condensing of the artery wall. The result of this allows a cardiologist to recommend the most efficient treatment.
While talking about the importance of cath labs, the Optical Coherence Tomography is more advanced imaging modality that gives magnified images than any other process. This is because it produces a high-resolution image of the artery which gives a clear understanding of the disease.
The process involves the OCT probe emitting an infrared light to create a high-resolution image. This specific technique was first established for ophthalmology, and then speedily improved for interventional cardiology. Through its use, there is a magnification of the image created without losing detail. To me, it feels like inserting an electron microscope inside the blood vessel.
OCT has 10-time greater resolution when compared to IVUS. The OCT permits the cardiologist to distinguish between different types gives of tissues and substances. IVUS informs whether artery has got plaque deposits. On the other hand, OCT will provide a cardiologist the information if the plaque deposits are rubbery, hardened, lipid-rich or heavy with cholesterol.
Case scenario: 58 year old male who is a known diabetic and hypertensive came with a chest pain of 2 days duration. He was investigated with ECG and ECHO. His ECG showed evolved heart attack and ECHO scan showed mild LV dysfunction. He was then taken to cath lab. His coronary angiogram showed double vessel disease. OCT showed (images shown below 1&2) ruptured plaques with organised thrombus. OCT helped to assess the correct size of the blood vessel and he underwent successful stent placement guided by OCT.
1. THROMBUS2.RUPUTURED PLAQUE
A doctor holds this in high regard in deciding the course of action. One can get rid of a lipid-rich plaque easily by using a balloon while conducting an invasive PCI procedure.However, when it comes to a calcified deposit, it becomes harder. It will consume more effort to remove such a plaque and it may need the use of a high-speed motor that sweeps away the deposit. This complex procedure is known as Rotablation.
OCT can also be used in order to perfectly place the stent during an angioplasty. With the use of the high-resolution images, a cardiologist can decide if the stent is permitting the free flow of blood and if it is able to sustain the artery walls. My experience tells me that OCT is very useful and will permit us to visualise if the stent is small, or still dangling and not attached to the blood vessel appropriately, or whether the stent is huge, and could contribute to the massive damage to the edge of the artery. The OCT empowers the cardiologists to make precise evaluations for placing the stents, which if placed properly will last long.
With the use of IVUS and OCT, cardiologists can make indispensable diagnosis to ensure that patients have no further complexities, and that they are able to live an improved and tension-free life.
Finally, by doing this, we are ascertaining to get a perfect result and guaranteeing long-term safety.