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Complex Coronary Artery Disease

Complex Coronary Artery Disease

Complex Coronary Artery Disease (CAD) refers to a group of conditions in which the coronary arteries have blockages or lesions that are challenging to treat. These blockages may be complex due to their location or disease characteristics. 

Complex coronary artery disease often requires advanced skills, techniques and technologies for a successful and safe treatment. 

Complex Coronary Artery Disease

The complex coronary anatomies include:

  • Chronic Total Occlusion (CTO)

Chronic Total Occlusion (CTO) describes a coronary artery that is blocked by plaques. This is one of the most challenging lesions to treat. Angioplasty or stenting for CTO lesions may take long hours in the Cath Lab and require careful attention to avoid complications 

Angioplasty for this category of coronary artery disease requires specialised techniques and devices, for example, dedicated coronary wires, retrograde (reversed direction) wire crossing technique, and specialised ‘re-entry’ devices – to cross wire back into the lumen of the artery segment beyond the lesion, etc. 

Chronic Total Occlusion (CTO)
  • Bifurcation Lesions of Coronary Artery

These are blockages that occur at branching points of a vessel. The angioplasty treatment strategy needs to ensure good outcomes for all the branches of the vessel and requires skilful and meticulous attention to angioplasty techniques.

  • Left Main Coronary Artery Disease

Left Main is the segment of the coronary artery that supplies the largest portion in the left side of the heart muscle and branches into two, sometimes three important branches. Experience, skills and proper techniques are essential to obtain a good and safe outcome. 

  • Unstable Angina or Heart Attack Situations 

A plaque that is causing a heart attack is often ‘ruptured’ or ‘cracked’ on its surface. It often contains overlying blood clots. Stent insertion during the angioplasty procedure may lead to disruption of the plaque content that may flow downstream and block the end vessels. Hence, treatment of these lesions may trigger another heart attack. 

  • Calcified Coronary Artery Disease 

Cholesterol plaque hardens over time. Doctors need to use special tools during the angioplasty procedure to treat calcified lesions before implanting a stent. Severe calcifications are often seen in elderly, diabetic, and renal failure patients. 

Source: Cleveland Clinic
  • Renarrowing of Bypass Graft after Heart Surgery

Bypass grafts after heart surgery especially the venous grafts degenerate and may re-narrow after a few years. Treatment of these grafts runs the risk of dislodgement of the degenerate plaque to the distal vessels, compromising blood flow. To prevent this, special filters may need to be deployed to capture these debris.

How to know if you have Complex Coronary Artery Disease?

Complex Coronary artery disease anatomy is defined after one has performed some imaging studies.

These include:

  • Catheter Coronary Angiogram

A coronary angiogram is a minimally invasive procedure. A small catheter is inserted via the arm or groin artery to the heart and an injection of contrast (‘dye’) into the coronary arteries enables visualisation of the blockages and their severity. 

  • Coronary CT Angiogram (CCTA)

CCTA is a non-invasive imaging technique that uses a CT scanner to create detailed images of the coronary arteries. It can detect and quantify calcium deposits (coronary artery calcium scoring) and visualize the extent and location of coronary artery disease.

  • Intra Vascular Coronary Imaging

During an angiogram procedure, an imaging device may be placed into the artery to investigate the lesion. Such devices include intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Information about the nature of the plaques including a high-risk ruptured plaque, vessel tear, blood clot, and extent of calcification may be obtained 

What are the treatment options for coronary artery disease at CVSKL?

  • Medical Treatment for a Healthy Lifestyle

All patients with coronary artery disease require optimal medical treatment and control of their coronary risk factors. Medical treatment complemented with a heart-healthy lifestyle is important to reduce the risks of future heart attacks and prevent and delay the progression of the disease. 

  • Percutaneous Coronary Artery Intervention (PCI) 

Many coronary artery disease patients may be treated with invasive coronary angioplasty procedures. This is often performed under local anaesthesia. This includes treatments with balloon angioplasty or stent placement.

  • Coronary Artery Bypass Graft (CABG) 

Coronary Artery Bypass Graft (CABG) is an open-heart surgery procedure. As a dedicated Cardiovascular Centre, we provide in-house Cardiothoracic Surgeons who collaborate with your Cardiologist for comprehensive management. Our Cardiac Rehab program after surgery facilitates patients’ early return to their normal daily functions and routines. 

Patients with coronary artery disease may have complex disease structure presentations. Some complex coronary artery disease requires experienced and skilful operators utilizing advanced techniques and technologies during the angioplasty procedure. The CHIP program at CVSKL is available to address the needs of their patients.