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Angiography And Stenning - A Breakthrough In The Field Of Vascular Disease Surgery

BY Dr Mohan murali Jangamsetty

Vascular diseases encompass a spectrum of conditions like atherosclerosis and peripheral artery disease and have long posed significant health risks globally. These diseases restrict blood flow, leading to severe complications such as strokes, heart attacks and limb ischemia.

Traditionally, diagnosing and treating vascular diseases posed challenges due to limited tools for precise imaging and intervention However, the advent of angiography and stenting has marked a significant breakthrough in managing vascular diseases.

Understanding Angiography

Angiography, a minimally invasive imaging technique stands as a pivotal diagnostic tool in assessing vascular conditions. Using contrast agents and X-ray imaging, angiography provides detailed insights into the extent and location of vascular issues, aiding in accurate diagnosis and treatment planning.

Procedure: Angioplasty, a minimally procedure involves the insertion of a catheter into a blood vessel, usually in the groin or arm, guiding it through the vascular system to the target area. Contrast dye injected through the catheter enables the visualisation of blood flow, identifying blockages, narrowing or any irregularities in the vessels. Beyond diagnosis, the real-time images obtained during angiography serve as a roadmap for accurate diagnosis and future interventions. Surgeons utilise this real-time imaging to navigate catheters and guide instruments to the precise location of blockages or lesions for effective treatment. The Emergence of Stenting

The diagnostic power of angiography would not have reached its full potential without the revolutionary intervention technique known as stenting. It involves the placement of small mesh tubes known as stents, typically made of metal alloys such as stainless steel or cobalt-chromium within narrowed or weakened blood vessels to restore blood flow. This facilitates reinforcing vessel walls and prevents further blockages, alleviating symptoms and reducing the risk of complications. These devices can be used in various vascular territories, including coronary, carotid, and peripheral arteries.

Procedure: Once an artery blockage is identified through angiography, interventional cardiologists or vascular surgeons can employ stenting to address the issue promptly. During the procedure, a catheter equipped with a deflated balloon and stent is guided to the affected area. Once in position, the balloon is inflated, expanding the stent and pressing it against the arterial walls allowing the vessel to remain open and restoring proper blood flow. The advent of drug-eluting stents, coated with medications inhibits cell growth, reducing the likelihood of re-narrowing or restenosis of the treated vessels, improving long-term outcomes compared to traditional bare-metal stents. This innovation has significantly decreased the need for repeat procedures, enhancing patient comfort. The Impact on Vascular Disease SurgeryThe amalgamation of angiography and stenting has redefined the landscape of vascular disease surgery. This innovative approach has significantly enhanced patient outcomes and reduced the invasiveness of procedures.

Minimally Invasive Interventions: Unlike traditional open surgeries, angiography-guided stenting procedures are minimally invasive. Smaller incisions and reduced risks of complications require shorter recovery times. Patients now experience less discomfort and enjoy faster restoration of their daily activities, marking a paradigm shift in their quality of life post-surgery. Additionally, the precision of angiography-guided interventions minimises damage to surrounding tissues and organs, ensuring targeted and effective treatment.

Personalised Treatment Plans: Angiography provides detailed information about the patient's vascular anatomy allowing for personalised treatment strategies. Surgeons can tailor interventions based on the specific location, severity and complexity of the vascular disease, optimising outcomes.

Evolutionary techniques: The continuous evolution of technology has paved the way for innovative approaches in the field. Advances like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) complement angiography offering enhanced imaging capabilities and aiding in precise stent placement.

Early Detection: The non-invasive nature of angiography has enabled early detection and intervention in asymptomatic individuals at risk of developing severe vascular conditions. By identifying and addressing issues before they progress, medical experts can implement preventive measures, potentially averting life-threatening complications.

Challenges and Future Directions

Despite these remarkable advancements, angiography and stenting in vascular disease surgery come with challenges and ongoing advancements.

Risk of Complications: While minimally invasive, stenting procedures still carry risks such as bleeding, infection or complications like thrombosis, involving blood clot formation within the stent. Continuous refinement of techniques and materials aims to mitigate these risks.

Advancements in Stent Technology: Ongoing research focuses on developing more advanced stent designs and materials. Innovations focusing on bioresorbable stents, which gradually dissolve after restoring blood flow, hold promise in reducing long-term complications.

Conclusion

The integration of angiography and stenting represents a transformative advancement in the field of vascular disease surgery. These cutting-edge procedures have transcended conventional approaches, ushering in a new era of revolutionised diagnostic precision, safety, treatment strategies and patient outcomes, offering hope to millions afflicted by vascular ailments worldwide. As ongoing research and technological advancements continue, the future holds promising prospects for further improving the effectiveness and safety of these procedures, enhancing patient well-being in the field of vascular medicine.

Dr Mohan murali Jangamsetty, MBBS, DNB( Gen Med),DrNB ( Cardiology), Apollo Spectra Hospital, Bangalore

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.Com does not necessarily subscribe to it. ETHealthworld.Com shall not be responsible for any damage caused to any person/organisation directly or indirectly)

Published On Dec 27, 2023 at 03:18 PM IST

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Cary Medical Center Now Offering Cardiac CT

CARIBOU, Maine — Cary Medical Center has become the first hospital in the County to offer a special diagnostic exam called "Cardiac CT" or coronary angiogram. This diagnostic exam uses powerful CT Scanning, along with intravenous contrast material to obtain high-resolution pictures of the heart and great vessels. The procedure is noninvasive and generally requires no recovery time.

A CT coronary angiogram is mainly used to check for narrowed or blocked arteries in the heart. However, it can check for other heart conditions. Shawn Laferriere, DO, chief of radiology at Cary Medical Center said that the hospital's recent purchase of a new, 'State of the Art', CT scanner, helped to make the new procedure possible. 

"Our new CT Scanner is equipped with advanced software and has the ability to construct detailed imaging of the heart and important arteries and vessels to identify potential problems that may require additional, more invasive treatment, or may rule out the need for such treatment," said Laferriere. "We have been very happy with the performance of our CT and the quality of the studies we have done".   

Lisa St. Peter, who was only the second patient and the first female to have this exam done at Cary, wanted to share her experience.  

"My experience was exceptional," she said. The entire team involved with this exam treated me with care and compassion and educated me every step of the way."

St. Peter explained that she was given two options for diagnostic procedures after alerting her doctor to symptoms she was having.  

"I began having intermittent symptoms this past summer. I tried to ignore them but they didn't go away. At my annual physical in October I shared my symptoms with my doctor. Considering my fairly young age, being female and having a reasonably healthy lifestyle my doctor didn't brush these symptoms aside and attribute them to stress or digestive issues but immediately ordered diagnostic tests which indicated that there were some issues," she said. "I had the choice of being referred to a cardiologist and potentially traveling outside of the County to have a cardiac catheterization or to start with the CT Coronary Angiogram with Calcium Scoring. I chose the Cardiac CT which could be done right here at Cary Medical Center."

Results of her Cardiac CT revealed that no further diagnostic testing was required.

The ability to have the Cardiac CT close to home has a number of advantages. Based on the results of the test it may prevent the need to travel outside of the area and the expense involved and may avoid having to experience more invasive procedures with additional recovery time.

"The biggest advantage," said St. Peter, is being cared for by our own health care providers who treat us like family."

Over the past year Cary Medical Center has put on line the advanced CT scanner and a new Magnetic Resonance Imaging instrument. The hospital continues to expand services and advance technology so that more care for patients can be delivered closer to their homes. Kris Doody, RN and CEO for Cary Medical Center said that the advanced technology is only part of the equation.

"We are very pleased to offer this new technology for the benefit of patients in Aroostook County. Our new CT and MRI have taken our diagnostic capability to an entirely new level," said Doody who is also CEO for Pines Health Services. "It is really the professional staff here at Cary that makes it all possible. They have the professional skills and confidence to deliver advanced procedures along with the empathy and personal approach that has become such a part of our culture." 

Prior to offering the new Cardiac CT procedure the radiologists at Cary had to complete additional, specialized training. All of Cary's radiologists have now successively completed the required training.

Dear Doctor: Why Aren't Angioplasties, Stents Used More Often In Patients With Coronary Artery Disease?

DEAR DR. ROACH: I am 68 and in good shape; I work out daily. I had a few episodes of angina two to three years ago and started going to a cardiologist as a result. I have had quite a few tests done, but the one that was really concerning was my coronary artery calcium score, which is over 4,800 (not a misprint).

He put me on 80 mg of atorvastatin, 10 mg of ezetimibe and 40 mg of valsartan. My blood pressure is good (generally around 110 over 65 mm Hg), and other than some shortness of breath, I feel fine. I'm wondering if my doctor should be more aggressive due to the extremely high CAC score (i.E., a stent). I would really like to hear your thoughts about this. -- C.B.

ANSWER: Your extremely high calcium score means you are at a very high risk for, and probably have, blockages in the arteries that provide blood to the heart muscle. This condition is called coronary artery disease (CAD).

There are several medications that have been proven to reduce the risk of heart attack and death in people with coronary artery disease: statins (80 mg of atorvastatin is the highest dose of one of the most effective statins); ezetimibe (which works along with the statin to stabilize blockages); and ACE inhibitors and angiotensin blockers (valsartan probably has benefits beyond lowering blood pressure to prevent heart disease), all of which you are on. If your doctor was sure that you really have CAD, you should probably be on aspirin and a beta blocker as well, unless there is an underlying reason not to be.

Although stents are commonly placed after cholesterol plaque blockages are opened through a balloon procedure, they have not been proven, despite many studies, to reduce the risk of heart attack and death in people who have stable coronary artery disease. (The story is different for people who experience an emergency like a heart attack.)

Angioplasties and stents are normally reserved for people who have symptoms of heart blockages that have not been treated successfully with medications. A recent and still controversial study cast doubt on how effective stents are at relieving symptoms.

I can't tell if your shortness of breath is a symptom due to blockages of the heart. A cardiologist's clinical judgment is necessary to determine whether a test, such as an angiogram, is appropriate to see how many blockages there are and their severity. Although a CT scan with dye can give excellent information, an angioplasty and stent placement can only be done during a cardiac angiogram.

In a few cases, the blockages are so severe that a decision is made to go directly into surgery, where one or more grafts can be placed to bypass the blockages found on the angiogram. There are specific indications for cardiac surgery. Medications are much more effective than they used to be, so there are far fewer coronary artery bypass graft surgeries (CABG, always pronounced "cabbage") performed now than in decades prior.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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