CHIP Programme: Heart Blockage
In CVSKL, interventional cardiology and complex high-risk percutaneous coronary interventions procedure (CHIP) program provides the finest treatment strategies from simple angioplasties to the most complex coronary diseases (heart blockages). Our team of heart specialists uses highly innovative and advanced technologies to deliver the most precise outcomes.
Intravascular Ultrasound (IVUS)
IVUS is an imaging technique that has become the international gold standard for the detection and evaluation of coronary artery disease. Designed to provide data about lesion characteristics, IVUS is used to improve decision-making regarding coronary intervention for patients. IVUS refers to a catheter or tube that has an ultrasound probe near its tip. An IVUS catheter can be placed in a coronary artery to look from the inside at the artery. It provides very detailed pictures of the inside of the artery and often provides more information than a standard angiogram alone.
How is IVUS different from Angiography?
Angiography provides a two-dimensional image whereas IVUS offers a cross-sectional detailed image of all the layers of blood vessel.
Although Angiography shows the narrowing of the blood vessel, it may not provide any information about the nature of the blockage or about the composition of the plaque. This information plays an important role in helping our doctor make a more informed decision about your treatment plan.
In current practice, IVUS is done in conjunction with angiography, and not as its replacement.
Intravascular Ultrasound (Source: Stanford Medicine)
IVUS aids your doctor to:
- Identify: The blockage and thus choose an appropriate treatment plan
- Select: The right stent size
- Confirm: The stent placement to minimize future risk
Image: Atheroma morphology by IVUS. Calcified atheroma (left), and soft (right) are illustrated.
Fractional Flow Reserve (FFR)
While many blocked arteries benefit from angioplasty and stenting, some do not. FFR is a special type of wire-based technology our doctors use to make that determination when it is not immediately clear.
Fractional flow reserve (FFR) is an index that can be measured with a coronary pressure wire in a patient with a moderate narrowing of unclear significance. The coronary pressure wire is a small wire with a pressure sensor near its tip that can be placed beyond the moderate narrowing. FFR is the ratio of the coronary pressure beyond the narrowing compared to the pressure before the narrowing. Measuring FFR provides more information than a standard angiogram alone about the significance of moderate coronary narrowings and its use improves patient outcomes.
In a rotational atherectomy, interventional cardiologists use a revolving instrument to break up calcified plaque that is clogging a coronary artery. Breaking up the plaque restores blood flow to the heart.
We use rotational atherectomies for particularly tough blockages. The procedure involves navigating a catheter fitted with a Rotablator device through the site of the blockage, under a local anesthetic. The device then rotates at a speed of up to 150,000 rpm, gently pulverizing the blockage into tiny particles that can pass safely through the bloodstream. The procedure takes effect almost immediately. Within approximately five minutes, your blood flow and heart function will improve.
Rotational Atherectomy (Source: Mount Sinai)
Impella® for Protected PCI
Percutaneous Coronary Intervention (PCI) is considered to be a high-risk procedure when involving patients with a severe heart condition and medical history. Protected PCI supported by Impella®, the world’s smallest heart pump reduces the functional burden of the heart in maintaining blood pressure and blood flow during the procedure.
This allows the heart to rest and recover as the pumping function to efficiently deliver blood and oxygen to the entire body is taken care of. With the use of Impella®, cardiologists can perform optimized procedures on the high-risk patient group and produce more favourable outcomes with a minimally invasive approach.
This temporary mechanical circulatory support is then removed at the end of the procedure. Clinical studies do show that the majority of protected PCI with Impella® patients experience improvement in their heart’s pumping function and quality of life.
(Source: Abiomed, Inc.)
Optical Coherence Tomography (OCT) Imaging
What is Optical Coherence Tomography (OCT) Imaging?
Optical coherence tomography (OCT) is a non-invasive imaging technique that uses light waves to produce high-resolution, cross-sectional images of biological tissues.
It works by measuring the echo time delay and intensity of backscattered light waves from different layers of tissue and using Fourier transform techniques to produce a depth profile of the tissue. OCT is commonly used in ophthalmology to diagnose eye conditions, but it also has applications in other fields such as cardiology, dermatology, and gastroenterology.