Angioplasty Doctor in Kolkata, India

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist, though was developed and originally performed by interventional radiologists.

Coronary artery bypass grafting (CABG), which bypasses stenotic arteries by grafting vessels from elsewhere in the body, is an alternative treatment. Most studies have found that CABG is better than PCI for reducing death and myocardial infarction. However, PCI does improve quality of life. PCI has proven to be as effective and less costly than CABG in patients with medically refractory myocardial ischemia.

Procedures:

The term balloon angioplasty is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery. While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.

Other procedures that are done during a percutaneous coronary intervention include:

• 1. Implantation of stents
• 2. Rotational or laser atherectomy
• 3. Brachytherapy (Use of radioactive source to inhibit restenosis.)

Technique:

The angioplasty procedure usually consists of most of the following steps and is performed by physicians, physician assistants, nurse practitioners, nurses, radiological technologists and cardiac invasive specialist; all of whom have extensive and specialized training in these types of procedures.

• During the x-ray visualization, the cardiologist estimates the size of the coronary artery and selects the type of balloon catheter and coronary guidewire that will be used during the case.Heparin (a "blood thinner" or medicine used to prevent the formation of clots) is given to maintain blood flow.
• The coronary guidewire, which is an extremely thin wire with a radio-opaque flexible tip, is inserted through the guiding catheter and into the coronary artery. While visualizing again by real-time x-ray imaging, the cardiologist guides the wire through the coronary artery to the site of the stenosis or blockage. The tip of the wire is then passed across the blockage. The cardiologist controls the movement and direction of the guide wire by gently manipulating the end that sits outside the patient through twisting of the guidewire.
• While the guidewire is in place, it now acts as the pathway to the stenosis. The tip of the angioplasty or balloon catheter is hollow and is then inserted at the back of the guidewire-thus the guidewire is now inside of the angioplasty catheter. The angioplasty catheter is gently pushed forward, until the deflated balloon is inside of the blockage.
• The balloon is then inflated, and it compresses the atheromatous plaque and stretches the artery wall to expand.
• If an expandable wire mesh tube (stent) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the artery from the inside.

The procedure involves implanting a half-dollar sized pacemaker, usually just below the collarbone. Three wires (leads) connected to the device monitor the heart rate to detect heart rate irregularities and emit tiny pulses of electricity to correct them. In effect, it is "resynchronizing" the heart.

Benefits of CRT

Because CRT improves the heart's efficiency and increases blood flow, patients have reported alleviations of some heart failure symptoms - such as shortness of breath. Clinical studies also suggest decreases in hospitalization and morbidity as well as improvements in quality of life.

Who is a candidate for CRT?

In general, CRT is for heart failure patients with moderate to severe symptoms and whose left and right heart chambers do not beat in unison. However, CRT is not effective for everyone and is not for those with mild heart failure symptoms, diastolic heart failure or who do not have issues with the chambers not beating together. It is also not suitable for patients who have not fully explored correcting the condition through medication therapies. To date, studies show CRT to be equally effective for both men and women.

In non-valvular AF, over 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage.The most common treatment for AF stroke risk is treatment with blood-thinning medications, also called oral anticoagulants, which reduce the chance for blood clots to form. These medications are very effective in lowering the risk of stroke in AF patients. Most patients can safely take these medications for years (and even decades) without serious side effects.

However, some patients find that blood thinning medications can be difficult to tolerate or are risky. Because they prevent blood clots by thinning the blood, blood thinners can increase the risk of bleeding problems. In select patients, physicians determine that an alternative to blood thinners is needed to reduce AF stroke risk. Approximately 45% of patients who are eligible for warfarin are not being treated, due to tolerance or adherence issues. This applies particularly to the elderly, although studies have indicated that they can also benefit from anticoagulants.

Left atrial appendage closure is an implant-based alternative to blood thinners. Like blood thinning medications, an LAAC implant does not cure AF. A stroke can be due to factors not related to a clot traveling to the brain from the left atrium. Other causes of stroke can include high blood pressure and narrowing of the blood vessels to the brain. An LAAC implant will not prevent these other causes of stroke.