Global Health Asia-Pacific June 2021 | Page 69

Current Advances in

PERCUTANEOUS

Coronary angioplasty , or percutaneous coronary intervention ( PCI ), was first performed in 1977 by Dr Andreas Gruentzig in Zurich , Switzerland . He inflated a tiny balloon within the coronary artery to open up a critical narrowing , immediately restoring blood flow . Since then , rapid worldwide adoption of PCI has treated numerous patients with coronary artery disease , saving many lives .
VASCULAR ACCESS
In this article , Interventional Cardiologist Dr Joshua Loh reviews the technological advances in PCI that have enabled more complex coronary disease to be treated .

CORONARY

INTERVENTION

WHERE DOES THE MINIMALLY INVASIVE
APPROACH IN PCI START ?
The contemporary approach for arterial
access in PCI is transradial access ( TRA ).
A small sheath is inserted through the radial
artery at the wrist using local anaesthesia – reducing bleeding , vascular complications and improving patient comfort compared to the traditional transfemoral access ( TFA ) through the groin .
CORONARY IMAGING
CAN I OPTIMISE MY STENTING RESULTS ? Intracoronary imaging can greatly improve the final result of the PCI . Advanced imaging catheters such as Intravascular Ultrasound
( IVUS ) and Optical Coherence Tomography
CORONARY PHYSIOLOGY
( OCT ) are used within the coronary arteries
DOES THIS NARROWING NEED TO
to
accurately
visualise
the
vessel
size ,
BE STENTED ? If a coronary angiogram shows severe narrowing , most cardiologists will perform a PCI . If there is minimal narrowing , PCI
characteristics of the narrowing , and help in precise sizing and placement of the stent . Scientific data show that using intracoronary imaging improves stenting results for better
is
not
required .
For
an
intermediate
long-term patient outcomes .
narrowing , a Fractional Flow Reserve ( FFR )
can objectively determine whether this narrowing requires PCI . Using an ultra-thin wire with a sensor inside the coronary artery , the pressure before and after the narrowing is compared . If there is a significant drop in pressure indicating poor blood flow , PCI is recommended . A modest drop in pressure indicates the narrowing is better off treated with medications .
CALCIUM TREATMENT
FIGHTING CALCIUM IN THE ARTERIES Heavily calcified narrowing is one of the toughest to treat . Calcification occurs as part of atherosclerosis ( cholesterol plaque build-up ) and is often seen in the elderly ; patients with renal failure ; and diabetics . A conventional balloon is often inadequate to crack open the rock-hard calcium . A highly
Dr Joshua Loh is a Senior Consultant
Interventional Cardiologist with
more than 10 years of experience
in the field . He has extensive
experience with complex coronary
intervention procedures .
www . capitalheart . sg specialised technique called atherectomy uses a diamond-encrusted drill within the coronary artery to crack the calcium . A newer approach uses a special lithotripsy balloon , which emits multiple shockwave pulses to fracture the calcium . These techniques allow the vessel to expand during stenting .
NEW GENERATION CORONARY STENTS
HOW GOOD ARE MODERN STENTS ? Ideally , drug-eluting stents ( DESs ) are used in PCI . New generation DESs use strong biocompatible alloys which are more flexible to implant and coated with anti-inflammatory drugs . Clinical data show that they perform exceedingly well , with good safety and very low rates of re-narrowing . In selected patients , a bioresorbable scaffold ( BRS ) can be used instead of a DES . A BRS is non-permanent and is resorbed over time . After resorption , natural vessel pulsatile movement resumes .
SUMMARY Innovations in PCI have opened up treatment options to patients with complex coronary artery disease who in the past , may only be treated with coronary bypass surgery or medications alone . Together with antiplatelet medications and effective cardiovascular risk factor control , one should expect a very good long-term outcome with PCI .