Laser Angioplasty in India A Revolutionary Approach to Cardiovascular Health.

What is Angioplasty?

Angioplasty is an artificial dilation of narrowed or completely blocked blood vessels.

Angioplasty is one of the modern minimally invasive methods, which is actively and effectively used in the treatment of many diseases associated with arterial damage, in particular, coronary heart disease, as well as atherosclerosis of the arteries of the legs. During the standard angioplasty technique, narrowed atherosclerotic plaques are widened with a long, thin catheter with a balloon at the end. This balloon is filled with saline solution, causing it to inflate and expand the lumen of the artery.

Feature of Angioplasty: 

Angioplasty is one of the methods of endovascular treatment . The advantage of angioplasty is that it is less traumatic for the patient and does not require general anesthesia or a long hospital stay. Angioplasty is considered a minimally invasive type of intervention on a vessel, since reconstruction is carried out from the inside. Angioplasty is usually combined with a stenting procedure . During stenting, a stent is implanted into the vessel, which subsequently keeps the vascular walls from narrowing.

Application: 

The angioplasty technique is considered one of the most effective ways to restore vascular lumen. It is used in the treatment of coronary artery disease , diseases of peripheral arteries and vessels responsible for blood supply to the brain. Angioplasty is performed in cases where the vessels of the circulatory system are narrowed and do not provide the organs and tissues with the necessary amount of blood. This intervention is prescribed when drug treatment of occlusion or stenosis does not produce an effect and the disease threatens life-threatening complications.

Types of Angioplasty: 

1.    Transluminal balloon angioplasty: is the most common method today for restoring the lumen of a narrowed or occluded vessel; at this stage, for the coronary, carotid arteries and arteries of the iliofemoral segment, in almost 90% of cases it is supplemented by stenting of the coronary arteries.                     

A stent is an openwork metal structure that reinforces the vessel wall, which, after deflating the intravascular balloon, remains in place in the area of the vessel expanded by the operation, firmly fixing the vascular wall from the inside. Thus, the stent becomes a guarantor of long-term dilation of the vessel with protection against possible repeated narrowing (restenosis).

2.    Excimer laser angioplasty: is a method preceding balloon angioplasty. In most cases, it is complemented by coronary stenting.

This method is also used to restore lumen in the coronary arteries. It consists of applying a laser catheter to the narrowing, which, using dosed radiation, clears the lumen of the vessel. This makes it possible to perform recanalization in severe cases.

Depending on the location of the vessels, the following are distinguished:

3.    Cardiac angioplasty or coronary angioplasty : This is an effective method of treating coronary heart disease and angina. It is classified as percutaneous coronary intervention (PCI). Coronary angioplasty helps prevent myocardial infarction or stop its development in the early stages.
4.    Angioplasty of vessels of the extremities: Used to treat vascular diseases of the legs . Angioplasty is recommended in the treatment of diabetic foot, obliterating atherosclerosis of the lower extremities, obliterating endarteritis and other ailments that are accompanied by ischemia of the extremities . 
5.    Angioplasty of the renal arteries: It is used in the treatment of diseases associated with damage to the vessels of the kidneys: renovascular arterial hypertension , renal artery stenosis, etc.

6.    Angioplasty of vessels: involved in the blood supply to the brain and head tissues. If the carotid or vertebral arteries are affected, there is a high risk of stroke. Angioplasty is one of the types of operations on the vessels of the neck , which is used along with open interventions. Angioplasty eliminates  carotid artery stenosis without traditional open surgery.

Angioplasty using Excimer laser: 

Angioplasty of coronary vessels using an excimer laser is a modern and effective method of treating complex lesions of the coronary (coronary) vessels that supply blood to the heart tissue. This approach has proven itself especially well in terms of correcting stenotic narrowing of the mouth of the right coronary artery and in non-calcified extended (more than 10 mm in length) stenoses.

Techniques for angioplasty of coronary vessels using an excimer laser: 

When removing atherosclerotic tissue, the excimer laser system has an undeniable advantage over other similar developments, since here the radiation penetrates to a shallow depth and causes limited damage to the walls of the coronary vessels - the penetration depth of non-calcified tissue is approximately 100 microns.
The currently used excimer xenon chloride laser generator produces ultraviolet waves with an average wavelength of 308 nm. Radiation is supplied to the atherosclerotic plaque (to the site of occlusion/stenosis) through a special fiber-optic catheter with a diameter of 0.9 to 2 mm with a concentric or eccentric arrangement of light guide fibers. The laser catheter is delivered to the intervention area via a guidewire installed distal to the site of coronary artery stenosis/occlusion. The heating-cooling technology used allows the blood and contrast agent in it to be washed out of the catheter system due to the constant infusion of physiological sodium chloride solution during each active phase of excimer laser ablation.
The essence of the entire technique is that under the influence of periodic pulses, liquid evaporates, causing the appearance of mechanical acoustic waves propagating along the inner wall of the coronary vessel and destroying pathological deposits on it, as well as breaking the C-C and CN bonds.
The maximum energy flux density produced by an excimer laser generator at a frequency of 40 Hz reaches 60 mJ/mm2. The laser ablation cycle consists of a five-second active laser exposure and a ten-second waiting period, which allows the doctor to determine the location of the catheter tip and adequately assess the degree of restoration of blood flow, as well as replenish the volume of the infusion pump (infusion pump). The latest laser catheters, having a diameter of 0.9 mm, allow the release of energy up to 80 mJ/mm2 at a frequency of 80 Hz, while the ablation cycle consists of a ten-second active phase and only a five-second standby phase.
The effect of excimer laser energy on thrombomass and atherosclerotic plaques is unique in nature. In addition to the properties described above, it has an additional positive effect on the process of myocardial revascularization and inhibits platelet aggregation (sticking together).

Indications for excimer laser coronary angioplasty

Indications for using this method are:
•    Occlusion of coronary vessels.
•    Restenosis in implanted stents.
•    Focal and ostial stenoses in autovenous shunts.
•    Unstable atherosclerotic plaques associated with the formation of blood clots.
•    Concentric and eccentric stenoses that cannot be eliminated with conventional balloon angioplasty.
•    Local stenoses of the coronary arteries in persons with a transplanted heart.
•    Extended stenoses.

Contraindications to excimer laser coronary angioplasty

Contraindications include those cases when the diameter of the affected coronary vessel is smaller than the size of the laser catheter or there is a large angulation (>45°), increased tortuosity of the proximal part of the vessel in which the stenosis is localized, perforation or dissection of the vascular wall has occurred and is not protected trunk of the left coronary artery.

How to prepare?

Angioplasty is performed routinely or urgently . In the latter case, the decision is made individually, for example, when a patient is admitted to a hospital with acute coronary syndrome , which indicates the development of myocardial infarction or unstable angina. If the doctor conducting the examination sees a need for this, the intervention is carried out simultaneously with angiography .
Angioplasty is performed in a specially equipped operating room, where X-ray equipment and recording equipment are installed. The patient prepares for planned angioplasty in advance - he will learn how to do this at an appointment with a cardiologist . On the eve of the intervention, the patient is asked to undergo additional examination, follow a diet, and take certain medications.

Possible risks during the procedure:

Like any intervention in the human body, angioplasty procedures are associated with some dangers:

1.    Rarely, an allergic reaction to anesthetics or radiocontrast agents occurs;
2.    The artery may be damaged by the conductor, which will require surgical intervention;
3.    The development of a hematoma at the site of puncture of the artery is not excluded;
4.    The possibility of developing a stroke cannot be ruled out .

Conclusion :

Thus, the excimer laser plays an important role in the cytoreduction of lesions in India that are difficult to overcome with conventional equipment, however, its effectiveness is reduced to a large extent by calcified lesions. Its role in acute myocardial infarction is potentially interesting but requires further research.
In clinical trials in India, the success rate in opening the passage in the coronary arteries are tremendous. In this case, the number of complications turned out to be less than in balloon angioplasty. Excimer laser coronary angioplasty has been widely and successfully used in India for the treatment of diseases in eye surgery and coronary heart disease.

Contributed by Dr Rakesh Kumavat (MBBS)
Team -  Proceed.Fit

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