The gold standard for the diagnosis of Coronary Artery Disease is by invasive Coronary Angiography. Upon detection of significant blockages in the coronary arteries, you may be advised to undergo Percutaneous Coronary Intervention (also known as “coronary angioplasty” or “coronary stenting”).
If the anatomy is not amenable to stenting, you may also be advised to undergo Coronary Artery Bypass Graft Surgery.
At The Heart & Vascular Centre, we provide the following procedures for coronary intervention:
This is a commonly performed low-risk invasive procedure that involves the introduction of a catheter (narrow tube) through an artery at your wrist or groin. Using X-ray and the simultaneous injection of contrast through the catheter, your coronary arteries can be visualized for the diagnosis of blockages that may restrict blood flow to your heart.
Percutaneous Coronary Intervention (PCI)
- If a significant narrowing of one or more of your coronary arteries is detected, you may be advised to undergo a PCI to relieve the narrowed portion of the blood vessel.
- Angioplasty involves the “opening” of the narrowed segment of the artery using a balloon.
- Most of the time, a stent is implanted to this segment of the artery. The stent acts as a scaffolding to keep the artery open and unobstructed. If a stent is implanted, you will be recommended to take blood-thinning medications for a period of time.
- Click here to read more about how a PCI is planned out for a patient in our clinic.
Complex Coronary Intervention
Complex coronary intervention is a term used when trying to balloon and stent blockages of the heart arteries that are:
- Heavily calcified (calcium in the arteries makes delivering balloons and stents to the narrowed segment of the artery more difficult)
- Chronically occluded (completely blocked which increases the difficulty of the angioplasty procedure)
- Very tortuous (artery has steep bends – this makes delivering balloons and stents to the narrowed segment of the artery more challenging)
- Narrowing involves the origin of the main arteries or if the narrowing is involving almost the entire length of the artery.
The intervention can be done via the groin or wrist with a high success rate although specialized equipment, e.g. rotablator drill and stiff wires, and greater technical skill may be required.
For complex coronary intervention, more advanced techniques have to be used to assist the ballooning and stenting of the heart arteries. Our interventional cardiologist can perform the following techniques. Based on each patient’s condition, he will select the one that is more suitable.
- Coronary Orbital Atherectomy
Coronary atherectomy is used for high-risk patients with severe calcium buildup in their coronary arteries. The arterial walls with severe calcification can become stiff and irregular such that ballooning and putting in a stent (angioplasty) is difficult.
The Coronary Orbital Atherectomy System (OAS) has a diamond-coated crown on the end of the catheter. The crown spins at variable speeds, gently sanding down built-up calcium plaque into tiny particles, which the body is able to absorb. The force of the orbital spin enables continuous blood flow, and as the crown gently pushes against the walls of the artery, it helps to restore the flexibility of the arterial wall, clearing the way to inflate the balloon and insert the stent.
- Intravascular Lithotripsy (IVL)
Intravascular lithotripsy (IVL) is a technique developed based on the treatment of kidney stones. In order to treat patients with severely calcified plaques in the coronary arteries, multiple lithotripsy emitters are mounted onto a catheter, which will deliver pulses of sonic waves at the specific location where the plaque is, to modify and crack the calcium. The waves create a localized field effect that travels through soft vascular tissue, selectively cracking intimal and medial calcium within the vessel wall. The balloon can then be used to expand the lumen, thereby restoring blood flow.
- Rotational Atherectomy
The device has a diamond-tipped burr that can quickly target and ablate the severely calcified plaque which is causing the severe blockage of coronary arteries. It can drill across severe, rock-hard calcification, creating a smooth lumen to enable stenting with complete expansion.
Coronary Artery Bypass Graft Surgery
Sometimes, the narrowing may not be amenable to angioplasty or may be blocked at critical positions that significantly increase the risk of angioplasty. You may then be recommended to undergo a Coronary Artery Bypass Graft Surgery by one of our trusted cardiac surgeon colleagues.