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Angiography/Angioplasty

Coronary artery diseases (CAD) affect millions of people in India, mainly the elderly population, making it a very common form of heart disease. Coronary artery diseases occur due to a condition known as atherosclerosis (narrowed and hardened coronary arteries). 

The percutaneous coronary intervention has emerged as the mainstay of invasive therapy for patients with coronary artery diseases. Coronary angiography and angioplasty are used in the diagnosis, analysis, and treatment of blockages in blood vessels but there are some drawbacks of this method of diagnosis. When coronary angioplasty is combined with this stenting method, it is referred to as percutaneous coronary intervention (PCI).

What happens in an angiography?

Angiography is a method to check blood vessels using X-ray. Before using an X-ray, the blood is dyed with a special color so that the blood vessels show clearly in an angiography. Using X-ray, the blood vessels are highlighted, allowing a cardiologist to see if there are any problems. The images, thus, created using X-ray are called angiograms. 

Why is angiography used?

Angiography is used to check if the blood flow through your arteries is obstructed due to some reason. CARE Hospitals provide this diagnostic procedure to diagnose or investigate numerous problems affecting the blood vessels of patients. These health problems include:

Atherosclerosis - This is a condition in which the arteries become narrow and can put the affected person at the risk of a heart attack or a stroke,

Peripheral arterial disease - this condition reduces the blood supply to the leg muscles,

Brain aneurysm - this occurs when there is a bulge in the blood vessels of the brain,

Angina - when blood flow to the heart muscles is reduced, there is a sharp pain in the chest and causes angina pectoris or heart attack,

Pulmonary embolism - blockage due to blood clots in the blood vessel supply to the lungs,

Blockage of blood clots in the blood vessels supplies blood to the kidneys.

Risks involved in angiography

Angiography is generally a safe and painless procedure. However, one may experience soreness, bruising, or a lump may form in the place where the cut was made due to the collection of blood. One may even show allergic reactions to the dye. There may even be health complications in very rare cases,  which include suffering a stroke or a heart attack.

Risks of angiographic reliance

Angiography has been most widely used for percutaneous coronary intervention (PCI) but it has limitations as well. Angiography provides us with a two-dimensional image (using X-ray) of a three-dimensional structure and does not help delineate the composition of the coronary artery. Additionally, angiography provides no information on plaque morphology or the severity or location of calcium. This method is also incapable of providing precise and reproducible lumen size.

Coronary angioplasty and its uses

Following a diagnosis, a treatment plan is made for patients with narrowed or blocked arteries. The term "angioplasty" means the use of a balloon to open a blocked artery. Using this procedure, a stent is placed in the place of blockage to stretch open a narrowed or blocked artery and allow blood to flow freely.

CARE Hospitals perform coronary angioplasty using state-of-the-art technology. We offer minimally invasive, advanced, and modern surgical procedures to make sure patients receive end-to-end medical care and recover faster with no post-surgery complications.

Angioplasty is generally used in the elderly population with atherosclerosis. People who have suffered from angina triggered by physical activity or stress can be treated by medications but angioplasty ensures continuity of blood supply even in severe cases when the medications may be rendered ineffective for some reason.

How can CARE Hospitals help?

At CARE Hospitals, the well-trained multidisciplinary staff adhere to international standards and protocols to perform minimally invasive procedures on patients following a precise diagnosis of heart ailments using our state-of-the-art technology, and advanced and modern surgical procedures. We also aim to make the recovery faster and hospital stays shorter, and provide out-of-hospital medical care. We use optical coherence tomography (OCT) along with angiography for documenting the internal structure of the blood vessels for clear viewing and diagnosing any structural abnormalities caused by blockages such as plaque.

Why use OCT?

Recent advances in interventional cardiology have highlighted the importance of conducting a detailed analysis of the tissue characteristics of coronary atherosclerotic lesions, including the identification of plaque stability and estimation of lesion covering. Optical Coherence Tomography (OCT) is a diagnostic procedure that is used during cardiac catheterization. Unlike ultrasound which uses sound waves to create imaging of tissue surfaces and blood vessels, OCT uses light to obtain images of blood vessels. By providing high-resolution images of the insides of an artery, OCT changes the nature of how patients are treated. OCT can be used pre and post-PCI to guide procedure planning and treatment decisions.

The three main applications of OCT are:

  • Atherosclerotic plaque assessment

  • Positional and coverage assessment of stent

  • PCI guide and optimization.

How does OCT work?

OCT uses light of almost infra-red wavelength to create images of the coronary arteries. This technique delivers very high-resolution images. The beam of light is projected at the artery, and some of the light reflects from inside the artery tissue while some light scatters which is filtered out by OCT. OCT allows cardiologists to see the inside of an artery in almost 10 times more detail than they would have while using intravascular ultrasound. 

OCT is used along with heart catheterization procedures, including angioplasty, in which cardiologists use a tiny balloon top to open blocks in a coronary artery. Many patients who undergo balloon angioplasty, receive a mesh-like device, called a stent, to keep the artery open. OCT imaging can help doctors to check if the stent is working properly or whether the stent has been placed correctly inside the artery. Not only that, but OCT imaging also lets doctors see if there is a plaque.

Advantages over Angiography Multiple studies indicate that intravascular ultrasound imaging is always better than dyeing and X-ray imaging for better clinical performance. OCT is an invasive diagnostic process and requires less time to provide highly accurate images. Fluorescein angiography involves the use of injectable dyes which take time to reach the vessels under study and may invoke allergic and anaphylactic reactions in the patient. In addition to the qualitative analysis done on standard angiography, the OCT-based approach provides a quantitative analysis of the blood vessels. As already stated, OCT provides three-dimensional imaging of the macula and visualizes capillaries, much unlike angiography which shows two-dimensional structures of three-dimensional structures. In terms of OCT's accuracy, studies reported a 90 percent specificity rate in comparison to the 67 percent rate useful to us by using angiography. Another advantage of OCT is its ability to visualise vasculature, enhancing the ability to visualise neovascular lesions and polypoidal growth. 

OCT provides an invasive and convenient tool for documenting and diagnosing vascular pathologies, with highly precise cross-sectional and three-dimensional displays. Despite these advantages, there is a lot more work to be done before the technology can be used routinely in patients along with angiography instead of using an angiographic method alone.

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