Primary Angioplasty

Primary Angioplasty is done in acute Myocardial Infaration (Heart Attack) to ensure early and complete opening of the arteries which are blocked.

Angioplasty is a procedure done under local anesthesia. We get to the blood vessel supplying blood to the heart muscle and remove blockages in the arteries supplying blood to the heart. There are three major arteries and branches supplying blood to the heart. When these blood vessels become narrow or blocked by deposits, the blood supply to the heart is reduced. When blood supply goes down, it usually produces what we call angina or pain in the heart. This is usually precipitated by exertion. Some groups of patients may not have the same symptoms. These are called cases of silent ischaemia. It goes unnoticed. Stress tests are commonly used to detect ischaemia. The confirmation is done by angiogram. When the arteries are blocked completely, they can produce heart attacks.

In angioplasty, we try to remove these blockages in order to re-establish the blood flow. Patients can usually get back to normal activity in three or four days.

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Latest developments in the field

Among the latest developments is atherectomy - cutting and removing deposits by using cutting devices or drills at two lakhs revolutions per minute. We do that in a moving heart, one that is functioning. Stents are another development. Stents made of stainless steel or other material are used to provide a scaffolding inside the artery to reduce the chance of the artery collapsing or re-narrowing. Other techniques are laser angioplasty and radiation during angioplasty, which are being tried in selected centers. Their long-term results are yet to be assessed.

In conventional angioplasty, we were only using a balloon to remove or compress the blockage. Now, with newer technology, we have been able to improve dramatically, the immediate and long-term results. And the risk of the procedure has been brought down substantially - to less than 0.25 per cent, against the risk of one to two per cent in surgery.

In the early 1980s, angioplasty was done only on patients who had single blockages or what we call single vessel disease. But from 1987-88 onwards, I began treating patients with multiple narrowing or multi-vessel diseases. Today, we have proved that this is a viable treatment with good long-term relief. The purpose of this treatment is to reduce the risk to life and give relief to patients who have symptoms of angina and are crippled and are unable to do their normal duties.

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