Refining Cardiac Care With Cutting-edge Technologies: Treating Coronary Artery Disease
When former Indian cricket team captain, Sourav Ganguly experienced chest pain and a heart attack twice within a month, he underwent angioplasty and three stents were implanted to clear his clogged artery. He was diagnosed with triple vessel disease which is an extreme form of coronary artery disease (CAD) – a disease in which cholesterol-containing deposits called plaques block the blood flow in coronary artery.
Ganguly is not alone. One in 4 deaths in India are now because of cardiovascular diseases with coronary artery disease and stroke responsible for more than 80 percent of this burden. A total of 4,38,351 percutaneous interventions were performed in 1 year period during 2018 and utilised 5,78,164 coronary stents with a 13.14 per cent increase in number of procedures from 709 centres. CAD has been at the forefront of mortality statistics in India and one of the most common treatments for it is angioplasty with stents and balloon catheters.
Angioplasty is a minimally invasive procedure that is carried to remove the blockage from the artery for a smooth flow of blood, ensuring heart muscles get adequate blood flow. When a person suffers from CAD, blocked and narrowed arteries can lead to heart attacks. Angioplasty saves a person from a heart attack as it restores the normal blood and oxygen supply to the heart. During the procedure, through a small puncture in the groin or arm, a tiny catheter is inserted to canulate the coronary arteries (the vessels which supply blood to heart muscle). Once the catheter is in the right spot, a balloon catheter is taken across the narrowed point in coronary artery over a wire and it’s inflated to remove the block from the artery by pushing the plaque to the wall of the artery. Angioplasty entails quicker recovery, helping patients to get back to their routine activities in a few days.
Most patients who undergo an angioplasty procedure also undergo stent implantation. The stent is placed on the balloon and when the balloon is inflated, the stent starts to expand outwards towards the vessel wall. While the stent stays in its place permanently, the balloon is then deflated and withdrawn. The doctor may insert one or more stents depending on the number of blockages.
The promise of cardiac care technologies to patients
As India is battling the burgeoning cardiac disease burden, doctors are now looking at advanced tools for better patient outcomes. The good news is, for cardiac care, there is an onslaught of cutting-edge technologies today that aid doctors in treating patients with varying disease profiles. To address the burgeoning burden of CAD, India requires superior quality cardiac care including gold-standard stents such as Drug Eluting Stents (DES) which reduces the chances of the repeat blocks inside the STENTED segment of the artery and ensures better long-term patency of these vessels. It reduces the chances of instant restenosis or narrowing of STENTED segment post angioplasty. DES is coated with medicines that help to eliminate the chances of in-stent thrombosis or narrowed arteries after the surgery.
Over the years, cardiovascular stents have revolutionized coronary artery disease-related procedures. Balloon angioplasty which was first introduced in 1977 was a major development in managing CAD. In 1986, the first human implantation of a self-expanding stent was carried and in 1987, the first human implantation of a balloon-expandable stent was carried. Due to continuous research by scientists, today we are endowed with sophisticated cardiac care technologies.
As a doctor, I am always looking for superior quality stents that have had lesser chances of repeat interventions for restenosis and before using any stent for my patient, I use the available external clinical evidence about their efficacy from systematic research. Patients who vest their trust in superior quality stents have not complained of complications such as bleeding or ischemic heart disease. For instance, the number of publications that collect a wide range of information and the latest scientific achievements on DES are increasing each year. These papers refer to the most frequently used preparation procedures for DES such as immersion, coating, and spraying methods.
Lifestyle changes – to live a heart healthy life and after angioplasty
If we analyse the reason behind the burgeoning burden of CAD in India, it can be the alarming rise in the prevalence of risk factors like hypertension, diabetes, obesity, smoking, and physical inactivity. Therefore, as prevention is better than cure, it is essential for people to live a heart healthy life by maintaining a healthy weight, exercising regularly, reducing stress levels, keeping high blood pressure and cholesterol levels under check, regular check-ups, drinking in moderation and quitting smoking. The same lifestyle changes are applicable for people who undergo angioplasty.
Fighting the cardiovascular disease burden: the road ahead
As India strives to manage its cardiovascular disease burden, there are certain challenges faced by the country. There are more than 6,000 medical devices available worldwide, but only one-sixth of them are made in India. Hence, the country remains highly dependent on imports for many types of medical devices.
At a time when the Indian medical devices market is estimated to reach USD 50 billion by 2025, a question that arises is - how likely is it for India to achieve this? Realizing its twin objectives of accessibility and affordability, the country needs to empower domestic manufacturing.
This is critical as the estimated prevalence of cardiovascular diseases in India was 54.5 million in 2016. As early signs of heart diseases are difficult to catch, early detection is the key to prevention, but that can only happen through regular check-ups and spreading awareness about the symptoms. That is why cardiac disease management in the country has been challenging – until technological advancements gave a ray of hope and started saving millions of lives.
