Treatment For Severe Blockages

Hi everyone,

I am Dr. Rahul Gupta. Today the topic of discussion is the latest and advanced treatment for severe blockages. Whenever a person develops a severe blockage. He develops multiple symptoms. The symptoms could be chest pain, burning, choking in the throat which comes on exertion and goes away with rest. Similarly, breathlessness, tiredness, extreme exhaustion. The diagnosis is done through angiography and the angiography tells us where these severe blockages are located. Now once the severe blockages are detected. There are a lot of questions, a lot of options are given as a patient or a relative, we are concerned as we are taking the right decision or what is the best way to treat.

So the treatment usually offered are either a bypass surgery, which is the open heart surgery whereby the blocks are not removed, but they are bypass through using the normal arteries of the body, which God has given it access. The other way of treating is angioplasty whereby without surgery we go through the groin and we put a balloon and then we put a stent over there and open up the block. The 3rd modality of treatment could be just medical management. So we are always in doubt what is the best way of treatment. Now there are a lot of patients who are in such kind of doubt. This doubt can be removed by a technology called fractional flow reserve. FFR is a technology whereby you put up pressure across the block and you see whether it is hemodynamically significant or not. So the block may be looking severe, but if it is not causing much trouble to the heart then it can be left on medical management.

Similarly, whether an angioplasty is good or bypass is good or just medical management, this FFR technology is the latest technology which helps us and I tried to use in most of my patients wherever these kinds of doubts are obtained. Similarly, there are a lot of patients who are a very high risk that means there are multiple blockages, but they have other comorbidities like they have lungs problem, kidney problem, liver problem and they become very high risk for bypass surgery. Then how do we deal with these kinds of patients? So there are latest technologies which can help us by which we can do a precision angioplasty. So there is a technology called as IVUS, which is intravascular ultrasound or optical coherence tomography, whereby a miniature camera goes inside the heart arteries and we can actually see how the block looks like, whether it is a soft block whether it is a calcified block, what is the size of the block, what is the length, what is the diameter. All these things can be known through these latest technologies and then we can actually decide what are the sizes of the stent that we want to use.

Similarly, suppose there is a lot of calcium. There is one technology called rotablation, which is a diamond-studded burr, which can actually drill the calcium and remove the calcium out of the block and then you can easily do an angioplasty, makes the process very much easier. So these latest technologies, they not only make the angioplasty extremely safe but it becomes very precise and the long-term outcomes also become very good because once you have done the procedure very well, then these patients do very well over a long period of time. Now like for example, in Apollo hospital where I do most of my cases we have all these facilities which are available. So if the patient is on the table and somebody decides that you want to go ahead with a very complex and challenging angioplasty, it is possible to do so at that time and whenever we have these high-risk patients, what we usually do is, we discuss these patients in a heart team.

The heart team at Apollo whereby a lot of doctors we sit together, we decide what is the best way of treating a particular patient. Whether we should do a bypass, whether we should do an angioplasty or whether we should leave it on medical management alone and once we have made a consensus we give it to you. The consensus is based on our personal experience as well as there are scientific scores which are available like SYNTAX score and there are other scores, which tells us that what will be the outcome of our strategy if it is done now or the future and this way the combined clinical approach, using of score and using the latest technology. We can actually make all these procedures which were previously undoable.

So a lot of patients who come to me for second and third opinions, they come with the thought process that a lot of doctors have told that this angioplasty even a bypass is not possible, but the heart is very weak and the patient is suffering. So these are the cases, which are called as CHIP cases (Complex high risk indicated patient), which as a team approach can be done very safely with the use of these advanced technologies. I hope this awareness session has made you aware about the latest technology and whenever there is any kind of need, you are free to approach your doctor or me, anybody whereby you can discuss these technologies and these technologies can be used for patient’s benefit. Thank you very much.