Angioplasty

Coronary angioplasty also called PCI or PTCA – is a minimally invasive procedure that helps treat coronary heart disease (blocked coronary arteries) by improving the blood supply to the heart muscle, through widening and opening of the narrowed coronary arteries . It is used to stop heart attacks in progress, treat chest pain (angina), and restore blood flow through the coronary arteries. Dr. Sengottuvelu is known for his pioneering work in complex angioplasty and stenting procedures. He has been a key opinion leader on stents and has evaluated different stent platforms from India and abroad.

The procedure of coronary angioplasty is performed in the cardiac catheterization laboratory (or cath lab) by a specialized Interventional cardiologist. Angiogram is performed prior to an angioplasty. From the digital pictures thus obtained of the contrast material, one can find out whether the coronary arteries are narrowed. The two types of angioplasty techniques are balloon angioplasty and stenting. Dr. Sengottuvelu pioneered the radial angiogram procedures in India leading to day care procedures with same day discharge.

Angioplasty

What is an Angiogram?

Angiogram is performed prior to an 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. Sengottuvelu pioneered the radial angiogram procedures in India leading to day care procedures with same day discharge. Angiogram procedure takes less than 10 minutes and done under local anaesthesia

What are the types of angioplasty techniques ?

Balloon angioplasty:

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.

Stenting:

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.

What is a catheter used for in Angioplasty ?

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.

What are the recent advances in Catheters ?
The ClearWay™ RX – Rapid Exchange Therapeutic Perfusion Catheter helps save larger area of heart muscle in heart attacks.

The CrossBoss Catheter is the latest technology for 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 specialised wires.

Rotablation

What & How?

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.

Whom?

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 a restenosis of the native vessel; or,
  • Native vessel atherosclerotic coronary artery disease that is less than 25 mm in length.
Who does it?

Dr Sengottuvelu G

GS Heart clinic, T Nagar, Chennai

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