Non-surgical angioplasty answer to heart trouble

Evolving technology and newer techniques make doctors opt for angioplasty while treating complicated heart disease.
Recently, a prominent political leader’s heart condition sparked off an age old debate between angioplasty and bypass surgery as the choice of treatment for coronary artery disease (CAD). While treating him the doctors opted for an angioplasty and successfully removed multiple blockages in the politician’s artery but the debate still continues.
Cardiac surgeons may insist that open heart surgery is the best way to fix such a severe heart disease, however, today non-surgical angioplasty technique has evolved to such an extent that even the most critical patient is safe in the cath lab. Angioplasty is a procedure where the clogged artery is cleaned out, and a stent - a tiny wire-mesh tube - is placed in the artery to help keep it open, allowing blood to flow freely through the heart again.
Previously the gold standard for treating a complicated heart disease like multiple clogged arteries was a bypass surgery, yet with the dawning of a new age of medicated stents and rapid advances in stent technology coupled with new intervention techniques like TAVI (Trans-catheter Aortic Valve Implantation) angioplasty has become safer and more reliable in treating multiple blockages. Elderly patients with narrowing of arteries could be treated safely by non surgical procedure like angioplasty. We see several such examples like in the recent case of Jayram Shetty, 84. He had a multi-vessel heart disease and left main artery blockage and was successfully treated with angioplasty using medicated stents. The recurrence rate for blockages is very low with the new medicated stents. In fact the stents can remain life-long if no recurrence occurs within a year.
A global study called SYNTAX, which compared surgery with angioplasty for patients with complicated heart disease, provided sufficient evidence for doctors to place their faith in angioplasty as a choice for treating such cases. Further scientific studies like the CARDIA trial and FREEDOM trial have also shown encouraging results in favour of angioplasty.
Angioplasty has become as safe and long lasting as a bypass for patients with multiple blocks in the heart. Being a non surgical process, it does not involve blood transfusions. Moreover the patient remains awake throughout the procedure as they don’t require anesthesia. The recovery time is quick and thus the patient can be discharged early from the hospital. This is very important in today’s scenario where everybody wants to get back to work as quickly as possible.
In India, of course, the decision between angioplasty and surgery is also based on costs. However, whether the choice of treatment is angioplasty or bypass surgery, it must be remembered that India has the dubious distinction of being the coronary disease and diabetes capital of the world where unhealthy lifestyle is on the rise. Hence it is very crucial for people in the age group of 35 years and above to get themselves checked at regular intervals and also to improve their lifestyle.
(Contributed by Dr Shahid Merchant, Interventional Cardiologist, Lilavati Hospital)