Cardiovascular diseases (CVDs) are one of the prime causes of mortality. In the medical field, many technological advancements are coming daily in the cardiovascular department. The latest techniques for heart patients in India are HD IVUS for superior cardiac care in PCI procedures.

Percutaneous Coronary Intervention (PCI or angioplasty with stent) is a minimally invasive surgical procedure to treat the blocked heart arteries from the plaque (atherosclerosis). Arteries carry oxygenated blood from the heart to all body organs. In this procedure, a surgeon uses a catheter (a thin, flexible tube), which uses a small balloon to reopen a plugged artery in atherosclerosis. After that, with the help of surgical instruments, a surgeon places a small stent in the coronary artery. Sometimes, the doctors use drug-eluting stents (medication-laden stents, which release drugs directly into the vessels) to decrease the risk of re-narrowing the coronary artery.

Indications of PCI

A surgeon suggests PCI pull out plaque build-up (atherosclerosis) in the arteries. Atherosclerosis is a root cause of various cardiovascular diseases, which block blood circulation in the heart and result in angina (chest pain).

The surgeons also recommend a PCI treatment approach for heart attack conditions.

PCI improves blood flow in arteries, decreases heart-related chest pain (angina), and improves the quality of life.

Procedure of PCI

Cardiologists with a specialization in operating cardiovascular system surgery can perform PCI. Following are the steps of PCI:

• The surgeon inserts a catheter into the blood vessels from the groin or the arm.
• With the help of fluoroscopy (a distinctive type of X-ray), the surgeon transports the catheter into the heart through the blood vessels to the location of the narrow coronary artery.
• When the tip of the catheter is in a narrowed artery, the surgeon inflates a balloon tip-covered stent.
• The balloon tip compresses the plaque and expands the stent in the coronary artery.
• After the compression of plaque and stent placement, the surgeon deflates the balloon and withdraws it. The stent stays in the artery, holding it open.

Highlighting the importance of imaging, Dr. Maqbool Sohil, Consultant Cardiology at Narayana Multispeciality Hospital Ahmedabad, “Imaging guidance during PCI is one of the key determinants of procedural outcomes because it is an integral part of every stage of PCI. During follow-up, imaging helps identification and management of mechanisms of stent failure in instances of restenosis or thrombosis.”

Use of intravascular ultrasound in percutaneous coronary intervention

Intracoronary imaging techniques such as intravascular ultrasound play a crucial role in percutaneous coronary interventions (PCI). IVUS is an invasive diagnostic procedure that uses a small sound probe (transducer) on the tip of a catheter. It uses high-frequency sound waves to produce detailed images of the inside of the arteries and gives an insight into a blockage. Cardiologists are increasingly using this advanced imaging to plan PCI in patients nowadays.

This intracoronary imaging is helpful in:

• Viewing the inside of the arteries. With the help of IVUS, we can get all details of the structures of the artery walls
• Assessing morphology of the lesions in intermediate stenosis
• Pre-procedural planning of surgery, such as stent size, landing zone, or an appropriate stenting technique
• Sizing the target vessel for stent
• Evaluation of stent expansion in the artery
• Optimization and management of immediate complications during PCI, such as thrombus, dissection, or tissue prolapse while surgery
• With the help of IVUS, the surgeon can assess the risk of myocardial infarction and angiographic no-reflow during surgery.
• Assessment of the adequacy of the PCI procedure
• During follow-ups, this imaging helps identify stent failure because of restenosis or thrombosis.

Advantages of IVUS

Elaborating the superiority of IVUS imaging in coronary procedures, Dr. Maqbool Sohil, Consultant Cardiology at Narayana Multispeciality Hospital Ahmedabad, adds, “Angiography was the gold standard for imaging during percutaneous coronary interventions, but it has significant limitations. Intravascular Ultrasound (IVUS) allows us to see a coronary artery from the inside out. This unique HD view provides us with a cross-section view and critical clinical information that is undoable with routine imaging methods, such as coronary-angiography (performed in the cath lab) or non-invasive CT scans.”

Following are some advantages of IVUS imaging:

• Three-dimensional view of a coronary artery
• It gives cross-sectional imaging of the vessels
• It provides enhanced tissue characterization, which allows detection and quantification of various plaque structure
• It measures the degree of narrowing of an artery due to plaque
• It can find the areas of external compression in a vein due to blood clots
• It can detect the presence and proportion of calcifications, necrotic tissues, neoangiogenesis, and neovessel formation.
• IVUS imaging is effective in high-risk groups, including patients with diabetes, ACS, and Impaired Renal Function.
• HD IVUS-Guided PCI is more cost-effective than Angio-Guided PCI.

Intravascular ultrasound (IVUS) is a recently developed advancement in imaging and can assess any artery in the body. This procedure is relatively safe and has few complications.