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Advanced Coronary Interventions & Heart Recovery Program

Percutaneous coronary intervention (PCI) refers to a family of minimally invasive procedures used to open clogged coronary arteries (those that deliver blood to the heart). By restoring blood flow, the treatment can improve symptoms of blocked arteries, such as chest pain or shortness of breath. Heart ASHIA interventional cardiologists, who are highly skilled and experienced in using the latest techniques and devices, are able to use PCIs to fix the most complex coronary artery blockages, even chronic total occlusions.

In a PCI, the doctor reaches a blocked vessel by making a small incision in the wrist or upper leg and then threading a catheter (a thin, flexible tube) through an artery that leads to the heart. The doctor uses X-ray images of the heart as a guide to locate the blockage or narrowed area, and then uses the most appropriate PCI techniques to open the vessel.

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. Dhamodaran K 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. Dhamodaran K pioneered the radial angiogram procedures in India leading to day care procedures with same day discharge.

Intracoronary Imaging IVUS, OCT

Intracoronary imaging techniques (intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) are routinely available to complement angiography in the management of coronary artery disease. Both IVUS and OCT are superior to angiography for quantification of vessel dimension and thus critically helpful in guiding coronary angioplasty (percutaneous coronary intervention (PCI)) and stent implantation

Intravascular imaging has revolutionized the precision of angioplasty. One type of imaging is the Intravascular Ultrasound, where a miniature probe is used to study the nature of the plaque. Where regular angiography shows only a two-dimensional silhouette of the interior of the coronary arteries, IVUS visualizes the coronary artery from inside-out. This unique point-of-view picture, generated in real time, yields valuable information.

Yet another innovative method of intravascular imaging is Optical Coherence Tomography [OCT]. This produces high resolution intracoronary images using infrared light. The new imaging technologies give crucial information whether the plaque blocking the vessel is hard or soft, is made up of lipids or calcium etc. They can also give accurate detail about the size of stent that may be needed, and assess post stenting status of the vessel as well.

Bioresorbable Vascular Scaffold

The Bioresorbable Vascular Scaffold (BVS) is a non-metallic mesh tube that is used to treat a narrowed artery. This is similar to a stent, but slowly dissolves once the blocked artery can function naturally again and stay open on its own.

Bioresorbable vascular scaffolds (BVS) are designed to provide mechanical support and drug delivery similar to the DES (drug eluting stent), followed by complete resorption over several years. Recent trials have demonstrated clinical non-inferiority of the BVS compared with contemporary DES. BVS is designed to help open up a blocked artery in the heart and restore blood flow to the heart muscle. BVS gradually dissolves once the artery can stay open on its own, potentially allowing the blood vessel to function naturally again.

Intracoronary Physiology (FFR)

Fractional Flow Reserve (FFR) a golden technology is now frequently used to determine if a cardiac patient really needs a stent or bypass surgery or can be kept only on medicines avoiding any procedure. FFR is defined as the ratio between distal coronary pressure and aortic pressure, both measured simultaneously at maximal hyperemia.

The difference in the pressure between these two points will give information on the severity of the block, and help to determine if the narrowing (block) needs to be cleared using procedures such as stenting, or whether it can be treated using only medicines. This scientific and evidence based procedure is beneficial to the patient as FFR technology not only saves lives while avoiding unnecessary surgery but also helps patients to save cost.

The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages. The point of opening up narrowings or blockages in the coronary arteries is to increase blood flow to the heart. But a number of studies have shown that if a “functional measurement”, such as Fractional Flow Reserve, shows that the flow is not significantly obstructed, the blockage or lesion does not need to be revascularized (angioplasty) and the patient can be treated safely with medical therapy

Transradial Intervention

The transradial technique is an effective, minimally invasive approach to perform coronary and peripheral angiograms and interventions

Transradial intervention (TRI) is a percutaneous coronary intervention (PCI) procedure done using the hand (wrist). In TRI, a catheter is inserted via the radial artery in the wrist to deliver stents to narrowed or occluded blood vessels such as coronary arteries. Dr. Dhamodaran K is a pioneer of radial approach in India. He was one of the earliest to adapt this approach in 2003. This patient friendly approach facilitates less pain, less bleeding and early discharge.

 Conversely, catheters may be introduced via transfemoral intervention (TFI), that is, through an artery in the upper leg. Such TFI procedures were once the standard for this type of treatment. Continued development of balloon catheters and stents, however, has enabled access through the smaller vessels in the wrist, or TRI. And, compared to TFI, transradial intervention seems to place less mental, physical, and economic burden on patients, which has led to this procedure becoming the new standard.

Rotablation

Rotablation uses a tiny drill with a diamond-tipped burr, powered by compressed air to break up calcified plaque (hard block) that is clogging the coronary artery. Breaking up the plaque restores blood flow to the heart.

With rotablation, a special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of the narrowing in your coronary artery. The tip spins at a high speed and grinds away the plaque on your artery walls. The microscopic particles are washed away in your bloodstream. This usually happens when the plaque is particularly hard, or is so narrow that the balloon used in normal angioplasty can’t pass through it.

A special catheter (a thin tube) is inserted along the wire with a tiny drill at its tip, powered by compressed air. This drill is used to chip away at the plaque to gradually widen the narrowing. Once this has been done, a balloon can be inserted and the angioplasty can proceed as normal.

Intra Vascular Lithotripsy

Intra vascular lithotripsy system has emitters enclosed within the balloon which generates sonic pressure waves when delivered selectively disrupts and fractures calcium improving blood vessel compliance and stent delivery and expansion.

The IVL catheter is introduced into the target vessel and is positioned across the lesion, using the marker bands as guides, to ensure the circumferential therapeutic field effect created by the emitters is adjacent to the calcium. The IVL catheter is connected via a connector cable to the generator that is preprogrammed to deliver 10 pulses in sequence at a frequency of 1 pulse/s for a maximum of 80 pulses per catheter.