Surgical reject Coronary Artery Disease managed by Laser Atherectomy, DEB Angioplasty at Kauvery Hospital

Chennai: Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals, a leading multispecialty healthcare chain in Tamil Nadu has announced a 'First time in India' successful procedure of Coronary Laser Atherectomy followed by the use of a Drug-Eluting Balloon, performed on a 56-year-old man. 

The 56-year-old man, who had a history of Coronary Artery Disease, and required liver transplantation, presented with narrowing within the stent after earlier treatments of Angioplasty, stenting, and Coronary Artery Bypass Surgery.

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Speaking on his condition, Dr R. Anantharaman, Senior Consultant Interventional Cardiologist, Kauvery Hospital said, "The person had angioplasty and stenting done to the left anterior descending coronary artery (a very important artery that supplies blood, and thus oxygen, to the muscles of the left ventricle of the heart), in 2006 and when this failed, he had coronary artery bypass surgery in 2010 to all three blood vessels of the heart.

He recently developed Liver failure and was advised of Liver Transplantation. His pre- transplant evaluation showed that the stent he received had narrowed and the bypass graft was not functioning. He was advised to undergo angioplasty and stenting again. But we faced challenges!

Patients who have liver failure have a very high risk of bleeding; another angioplasty and stenting will require the patient to take blood thinner medications which also increase the risk for bleeding. Also, he has to continue the medication for a certain period which would delay the Liver Transplant by several months."

The angiogram had indicated that the previously placed stent had narrowed and the Bypass Graft to the left anterior descending artery was also blocked. "We then discussed with our team of medical experts and carried out an Intravascular ultrasound (IVUS) Imaging which helped us to see that the previously placed stent was small for the artery which proved to be the main cause for the stent to narrow in the first place. We proceeded to do an IVUS image-guided Excimer Coronary Laser Atherectomy (ECLA) procedure which ablated the tissue inside the previous stent," added Dr Ananthraman.

Following this, a Drug-Eluting Balloon procedure was performed where a balloon coated with the drug was used to dilate the stent and restore the diameter of the lumen of the stent to its original status. It was also designed to deliver a drug into the stent which significantly reduced the chances of narrowing again.

He was still required to take blood thinner medications for a month which would be stopped before the Liver Transplantation to avoid bleeding.

Coronary angioplasty and stenting have emerged as an alternative to bypass surgery over the last 4 decades. However, the results with bare metal stents are not considered satisfactory, as a significant proportion of patients develop narrowing within the stent in less than 6 months. Subsequent development of Drug Eluting Stents (DES) has reduced the re-narrowing rates significantly.

Speaking on the success of the treatment, Dr Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Hospital Chennai, said, "This is probably the first of its kind medical procedure in the country, where the person had to undergo Coronary Laser Atherectomy and treatment with a Drug-Eluting Balloon in preparation for Liver Transplant. We were fortunate enough to provide the person with this treatment as we are the only facility in Chennai to have Laser Atherectomy, which is a suitable alternative treatment for high-risk patients with no other options. I would also like to applaud the brilliance of Dr Anantharaman and team who used our State-of-the-art medical infrastructure to explore newly developed methods to address and resolve such medical complexities in patients. These breakthroughs will save many lives in the future".

The person is currently stable and awaiting Liver Transplantation.

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