Complex Coronary Angioplasty

Our heart is a natural pump with tremendous efficiency. It supplies blood to the whole body. Coronary arteries are relatively small but vital blood vessels that supply blood to the heart itself. Blockades in these blood vessels mainly due to cholesterol deposition lead to minor or major heart attacks which are potentially life threatening.

Historically bypass surgery was the only treatment option available for these blockades. This is a supra-major surgery with its own drawbacks like long recovery time, perioperative morbidity and mortality. In 1977, Dr Andreas R. Grüntzig invented the less invasive treatment option - Coronary Angioplasty. Angioplasty is a percutaneous procedure where the cardiologists pass a balloon over a wire in the coronary arteries through a small tube-like guiding catheter, and blockades are dilated to improve the blood flow through them. Initially, it was a crude method, nothing else could be done, subsequently, stents were invented which are metallic scaffolds implanted at the site of the block to prevent re-block. In the last three decades, stents quality has significantly improved with fewer complications and excellent outcomes.

Although angioplasty was discovered way back in the 1970s, still till recently, complex cases were managed by bypass surgery. Examples of the complex cases are hard calcified blocks, tortuous vessels, multiple long blocks or blocks at difficult locations of the vessels etc. With cutting-edge techniques manging, these challenging scenarios have become possible via angioplasty. Internal imaging techniques like optical coherence tomography (OCT) or Intravascur ultrasound (IVUS) made it possible to properly delineate the properties of the blockades like the length of the block, presence of calcium or diameter of the stent to be used etc. So that a stent can be implanted in places like the left main coronary artery with ease. Guide extension catheters are become available for tortuous arteries where passing a balloon or stent is usually very difficult.