Cardiovascular diseases (CVD) are one of the leading causes of death. In the medical field, there are many technological developments in the cardiovascular department on a daily basis. The latest techniques for cardiac patients in India are HD IVUS for superior cardiac care in PCI procedures.
Percutaneous coronary intervention (PCI or angioplasty with stent) is a minimally invasive surgical procedure to treat the blocked heart arteries of the plaque (atherosclerosis). Arteries carry oxygenated blood from the heart to all body organs. In this procedure, a surgeon uses a catheter (a thin, flexible tube), which uses a small balloon to reopen a blocked artery in atherosclerosis. Then, using surgical instruments, a surgeon places a small stent in the coronary artery. Sometimes the doctors use drug-eluting stents (drug-loaded stents that deliver drugs directly into the vessels) to reduce the risk of coronary artery restriction.
Indications of PCI
A surgeon suggests PCI to remove plaque buildup (atherosclerosis) in the arteries. Atherosclerosis is a main cause of several cardiovascular diseases, which block blood circulation in the heart and lead to angina pectoris (chest pain).
The surgeons also recommend a PCI treatment approach for heart attack conditions.
PCI improves blood flow in the arteries, reduces heart-related chest pain (angina) and improves quality of life.
Cardiologists with a specialization in operative cardiovascular system surgery can perform PCI. Following are the steps of PCI:
- The surgeon inserts a catheter into the blood vessels from the groin or arm.
- Using fluoroscopy (a separate type of X-ray), the surgeon advances the catheter in the heart through the blood vessels to the site of the narrow coronary artery.
- When the tip of the catheter is in a narrowed artery, the surgeon inflates a balloon-tipped stent.
- The balloon tip compresses the plaque and expands the stent in the coronary artery.
- After plaque compression and stent placement, the surgeon deflates and retracts the balloon. The stent stays in the artery and keeps it open.
Emphasizing the importance of imaging, Dr. Maqbool Sohil, cardiology consultant at Narayana Multispeciality Hospital in Ahmedabad,Imaging guidance during PCI is one of the most important determinants of procedural outcomes, as it is an integral part of each stage of PCI. During follow-up, imaging helps identify and manage mechanisms of stent failure in cases of restenosis or thrombosis.”
Use of intravascular ultrasound in percutaneous coronary intervention
Intracoronary imaging techniques such as intravascular ultrasound play a crucial role in percutaneous coronary interventions (PCI). IVUS is an invasive diagnostic procedure that uses a small sound probe (transducer) on the tip of a catheter. It uses high-frequency sound waves to create detailed images of the inside of the arteries and provide insight into a blockage. Today, cardiologists are increasingly using this advanced imaging to plan PCI in patients.
This intracoronary imaging is useful in:
- View the inside of the arteries. With the help of IVUS, we can get all the details of the structures of the arterial walls.
- Assessment of the morphology of the lesions in intermediate stenosis
- Preprocedural planning of the surgery, such as stent size, landing zone, or appropriate stent technique
- Target vessel sizing for stent
- Evaluation of stent expansion in the artery
- Optimization and management of immediate complications during PCI, such as thrombus, dissection or tissue prolapse during surgery
- Using IVUS, the surgeon can assess the risk of myocardial infarction and angiographic no-reflow during surgery.
- Assessment of the adequacy of the PCI procedure
- During follow-ups, this imaging helps identify stent failure due to restenosis or thrombosis.
Benefits of IVUS
Elaborating the superiority of IVUS imaging in coronary procedures, Dr. Maqbool Sohil, cardiology consultant at Narayana Multispeciality Hospital in Ahmedabadadds: “Angiography has been the gold standard for imaging during percutaneous coronary interventions, but it has significant limitations. Intravascular ultrasound (IVUS) allows us to view a coronary artery from the inside. This unique high-definition view provides us with a cross-section and critical clinical information that can be reversed by routine imaging methods, such as coronary angiography (performed in the catheter lab) or non-invasive CT scans.”
The following are some of the benefits of IVUS imaging:
- Three-dimensional image of a coronary artery
- It gives a picture of the cross-section of the vessels
- It offers improved tissue characterization, enabling detection and quantification of various plaque structures.
- It measures the degree of narrowing of an artery due to plaque.
- It can find the areas of external compression in a vein due to blood clots.
- It can detect the presence and proportion of calcifications, necrotic tissues, neoangiogenesis and new blood vessel formation.
- IVUS imaging is effective in high-risk groups, including patients with diabetes, ACS, and renal impairment.
- HD IVUS-Guided PCI is more cost effective than Angio-Guided PCI.
Intravascular ultrasound (IVUS) is a recently developed advancement in imaging and can assess any artery in the body. This procedure is relatively safe and has few complications.