Relying on breakthrough treatments: Offering hope to patients with coronary artery disease

Dr Praveen Chandra, Chairman-Interventional & Structural Heart Cardiology, Interventional Cardiology, Medanta Heart Institute talks about breakthrough treatments in cardiology

On a summer afternoon, 52-year-old Mohan complained of a severe chest pain and shortness of breath. After persistent pain, he collapsed and was rushed to the hospital. A coronary angiogram revealed a blockage is his coronary artery. Mohan had been living with diabetes for many years and also had hypertension, a lot due to his stressful routine. To guide his treatment decision and, whether stenting was required or not, the doctor decided to carry out further investigation using a procedure called fractional flow reserve (FFR).

FFR is conducted to rule out the uncertainty in the requirement of stenting. It is a micro sensor-based procedure which is conducted to measure the pressure difference across a blocked artery. Once it was decided that Mohan needed a stent, an imaging technique called optical coherence tomography (OCT) helped the doctor in visualising the severely blocked artery with precision. OCT is a high-definition imaging modality which gives a clear view of the inside of the coronary arteries. Before stenting, this technology helps doctors to understand the blockage in detail – evaluating the percentage, characteristic and length of the blockage, and most importantly, the diameter of the artery where the stent has to be placed. Post stent implantation, OCT was conducted to validate if the stent is well expanded and properly placed, thereby helping avoid any complications post-procedure.

This is what advanced cardiac care technologies are doing for patients with clogged coronary artery or coronary artery disease – they are lending great precision in decision making that not only optimises treatment procedures, but also presents long-term solutions to reduce revision surgeries and patient re-procedure rate.

As a cardiologist, I must say that intravascular imaging has played a huge role in moving guesswork out of stent sizing for precision percutaneous coronary interventions (PCI). It helps physicians like us during stent implantation by allowing direct imaging of patients’ vessels to facilitate the accurate measurement of dimensions so they can choose the best-fitting implant. Let us understand the need and how technologies such as OCT and FFR are making interventional cardiology more advanced.

Precision that yields better patient outcomes

Blockages in blood vessels are identified through a coronary angiogram and based on that it is decided whether the patient needs a stent or an open-heart surgery or only medicines. This approach works well when the angiogram shows either a severely blocked blood vessel or a normal one. However, it has its own limitations – blockages of moderate severity are often difficult to determine. This is where precision imaging and diagnostic techniques come in.

By producing 3D view of the artery. imaging procedures are addressing the gaps in conventional angiography that gives a two-dimensional view of the artery. High resolution images of the blocked coronary artery help doctors at the point of care recognise the vulnerable plaques that can lead to fatal events and increased coronary complications. Based on the microscopic images of blood vessels, the doctor can determine if stenting is required or can be avoided. And if stenting is needed, the images can aid the doctor in taking accurate measurements of the stent before and after the placement. It is critical to understand that in cardiac care, there cannot be one-size-fits all approach as every patient has different needs. For instance, a doctor will consider a different stent for a person with diabetes than for one without any underlying complications.

Moreover, procedures such as FFR provide the doctor with a score to identify the exact location of the lesion where stenting is required, improving patient outcome. This is done by measuring the volume of the blood flow and oxygen supply to distal part of the blocked artery. FFR is an easy invasive procedure done along with angiography. A study that reviewed 17,989 patients revealed that the use of FFR, significantly improved one-year mortality rates in adults with stable ischemic heart disease. In fact, the procedure is the first line of assessment tool in developed countries such as USA and Japan with highest level of clinical evidence and it is also a part of ESC International guidelines.

We are witnessing a defining moment in patient care – a moment where innovative technologies are resolving some of the daunting challenges in managing the cardiovascular disease burden of India. These technologies have become indispensable in delivering patient care. When technologies aid doctors in providing precise and evidence-based treatment, it eliminates the chance of any clinical error and repeating procedures. Therefore, it is about time to acknowledge how the landscape of cardiac care is changing in India, promising a better quality of life for patients.