Metal-Free Angioplasty: A Stent-Free Breakthrough in Cardiology

A 78-year-old patient with a complex cardiac history arrived at Narayana Hospital RN Tagore Hospital, Kolkata with severe chest pain. Instead of traditional stent placement, we employed advanced plaque-modifying technology to open the blocked artery, ensuring better long-term outcomes.

Past Medical History / Co-morbidities:

Underwent bypass surgery 20 years ago with three grafts.
Known history of severe coronary artery disease.

Symptoms being faced by the patient & since how long:

Severe angina (chest pain), progressively worsening over time.

In what condition was the patient brought to Narayana Hospital? Did he come to the OPD or was he brought to the ER?

The patient presented to the OPD with worsening chest pain and reduced exercise tolerance.

Diagnostics done at the hospital:

Coronary Angiogram: Showed that only one graft (LIMA-LAD) remained patent, while there was a severely calcified, long-segment blockage in the right coronary artery and the left main to LCx coronary artery.
Optical Coherence Tomography (OCT): Provided high-precision imaging, revealing an extensively long and deeply calcified lesion.

Details about Treatment Planning + Surgery / Intervention:

Given the complexity of the lesions, multiple advanced technologies were used:

Orbital Atherectomy: Utilized to modify and debulk the calcified plaque. This cutting-edge tool, featuring a diamond-coated rotating burr, sanded down the calcium at speeds of 80,000–120,000 rpm.
Paclitaxel-Eluting Drug Balloon: Instead of placing a metal stent, a drug-coated balloon was used to keep the vessel open and minimize the risk of restenosis.

Challenges faced by the specialist during the course of treatment. How was it ensured that the surgery / intervention / medical management goes complication-free?

The major challenge was reopening an artery that had been occluded for over 20 years due to heavily calcified and long-segment blockage.
Modern high-tech tools such as OCT imaging and Orbital Atherectomy were employed to ensure precise plaque modification and safe restoration of blood flow without complications.

How long did the surgery / intervention / medical management take?

The entire intervention lasted approximately 2.5 hours.

Details about recovery of the patient. How was the patient taken care of in the hospital?

The patient was closely monitored in the Cardiac Care Unit (CCU) post-procedure.
He was placed on optimized medical therapy and underwent cardiac rehabilitation to ensure a smooth recovery.

Length of patient stay at the hospital:

The patient was discharged after 48 hours with no complications.

Brief explanation about the case and what makes it unique (in simple language):

This case highlights the advancements in interventional cardiology that allow for treating severe coronary artery disease without the use of metal stents. The patient, who had undergone bypass surgery 20 years ago, had an artery completely blocked for decades. Thanks to cutting-edge technology like Orbital Atherectomy and Drug-Coated Balloons, we successfully restored blood flow without a stent, reducing future complications and ensuring a better quality of life.

Main Highlight of the case that should be pitched to media:

Metal-Free Angioplasty: A Stent-Free Breakthrough in Cardiology. This case demonstrates how advanced techniques like Orbital Atherectomy and Drug-Coated Balloons can successfully treat long-standing, calcified coronary blockages without requiring metal stents.