Stenting and Bypass Surgery for Patients with Left Main Coronary Artery Disease

The heart is a fist-sized powerhouse that pumps oxygen and nutrient-rich blood throughout the body to keep us alive. Aorta that bifurcate into two major coronary arteries – Left Main Coronary Artery (LMCA) and Right Coronary Artery (RCA) supply blood to the heart tissues keeping them nourished so that they can function perfectly. Left Coronary Artery also known as Left main stem coronary artery (LMS) branches into Left Anterior Descending Artery (LAD) and Left Circumflex Artery that supplies the left side of the heart muscles and front of the septum with blood. While the Right Coronary Artery divides into the Right Marginal Artery and Posterior Descending Artery which supplies blood to the right side of the heart and sinoatrial nodes. Hence, any blockage in the coronary arteries will disrupt or cut off the blood flow to the heart muscles (myocardium), resulting in its damage or death. 

Plaque that builds up in the coronary arteries as a result of atherosclerotic condition is the major cause  of restricted blood flow. Coronary arterial stenosis of greater than or equal to 50% narrowing is associated with multivessel disease and is termed as the significant left main disease (LMD). Patients with coronary heart disease often suffer from severe chest pain and discomfort as the heart becomes starved of oxygen and nutrients.  In some cases, whenever there is a clogging in the right or left main coronary artery, the collateral vessels become active, and bypassing the blockage they serve as alternative conduits for blood flow. However, it is not a cure or standard medical care option to rely on the functioning of collateral arteries. 

Medical therapy and surgical revascularization (Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention) are the main options available for treating coronary arterial stenosis. Medical therapy was not proven beneficial  for treating LMD as the survival rates were far below.  Performing bare-metal stenting often ended up in higher restenosis rates, acute thrombosis and repeat revascularization. Hence, Bypass surgery (CABG) turned out to be the standard of care for left main disease as it improves the likelihood of survival. 

 

However, advancements in catheterization and medical imaging techniques such as FFR and Optical Coherence Tomography (OCT) have led to the resurgence of interest in Percutaneous coronary Intervention (PCI). Providing a detailed and clear visualization of coronary morphology, OCT has evolved as an indispensable tool for developing new types of coronary stents. Optical Coherence Tomography when used as a guide for coronary interventions ensures better outcomes. Even though, CABG remains to be the superior choice for treating left main CAD, cardiologists hope that the ongoing studies and trials may bring more light into the role of percutaneous approach in near future.

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Treatment of Coronary Artery Stenosis

We have been hearing a lot about the rapid advancements and changes in the field of medical technology ranging from patient registration to data assessment and diagnostic methods to surgical procedures. Yet, some diseases continue to remain as a dreadful term for us; heart disease is a case in point. Coronary Heart Disease (CAD) also known as Coronary Artery Disease (CAD) is the most common type of heart disease that kills more people than any other disease across the world. The main cause of CAD is atherosclerosis (hardening of arteries). Build-up of calcium and cholesterol on the walls of coronary arteries cut down the blood supply to the heart muscles, thereby leading into cardiac ischemia or myocardial infarction (heart attack) among CAD patients.

Severe chest pain or discomfort, also termed as angina pectoris is one of the major coronary heart disease symptoms. The pain can be localised to shoulders, arms, neck, jaw or back. Though, in some cases people also experience nausea, shortness of breath and dizziness. The sensation of discomfort experienced during myocardial ischemia or myocardial infarction develops as a result of coronary artery stenosis. As the degree of coronary artery stenosis increases, myocardial blood flow is reduced resulting in severe chest pain.

Treatment plans differ according to the types of angina, which includes stable angina, unstable angina (UA), variant angina and microvascular angina. When stable angina follows a regular pattern, UA typically occurs when a person is at rest which demonstrates its highest unpredictability and risky nature. On the other hand, variant angina is a rare kind induced due to spasm in the coronary artery and can be treated with medical therapy. Severe pain persists for a long time when it comes to microvascular angina. Patients admitted with coronary heart disease symptoms are advised to undergo different laboratory tests and imaging studies to devise a treatment plan.  

Surgical intervention or medical therapy is the preferred treatment approach to tackle coronary artery stenosis. However, interventional cardiologists find it challenging to deal with coronary bifurcation lesions (a lesion in the parent coronary artery very close or involving a significant side branch) that increases the procedural complexity. An optimal surgical or medical approach for managing coronary artery bifurcation lesions is still on debate as it involves restoring lumen of both the vessels. Time is the main factor in managing angina; hence it is essential to make a quick and safe decision based on the results.

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Fractional Flow Reserve Measurement and Optical Coherence Tomography in Guiding Coronary Interventions

Blockage of oxygen-rich blood supply to the heart due to the plaque build-up in coronary arteries is the primary cause for heart attacks. Termed as Coronary Artery Disease (CAD), this heart problem occurs due to a condition called atherosclerosis.  In some cases, plaque build-up is not just limited within a single epicardial vessel but to multiple vessels known as Multi vessel CAD or coronary multivessel disease. If defined in medical terms - "a condition where 70% or greater stenosis is affected in at least one major epicardial vessel and 50% or greater stenosis is affected in at least other major vessels".

Though coronary angiography has been considered as the ‘gold standard’ for diagnosing ischemic heart conditions, it has many limitations. It often failed in providing comprehensive and accurate information about the physiological significance of lesions. That is when the well-validated Fractional Flow Reserve measurement came into the limelight. Performed along with the cardiac angiogram, it has been proved as a safe and reliable diagnostic tool to differentiate between ischemic and non-ischemic stenosis.

On the other hand, medical imaging techniques such as Intra Vascular Ultra Sound (IVUS) and Optical Coherence Tomography (OCT) have found a place in interventional cardiology. Functional severity of stenosis, plaque morphology and intraluminal coronary dimensions are some of the many features that can be assessed with IVUS.  Whereas, OCT is slightly more efficient than the IVUS technique as it offers microscopic visualization of ten-times higher resolution. Advanced Optical Coherence Tomography technique renders clear and detailed pathophysiology of atherosclerotic plaque. 

In terms of treatment choices for multivessel diseases, we presently have surgical management and medical therapy. Revascularization methods include Percutaneous Coronary Intervention (PCI) or angioplasty and Coronary Artery Bypass Graft (CABG) or bypass surgery. Reliable Fractional Flow Reserve Measurement value along with angiographic data helps physicians decide between PCI and medical therapy for single vessel CAD. Negating the need of repeated revascularization and relieving the likelihood of angina to a greater extent, CABG appears to be a superior choice over PCI when it is concerns treating multivessel disease. However, with the advancements in catheterization, medical imaging and stenting techniques, physicians are shifting away from the aggressive bypass surgical procedures and opting for less-invasive percutaneous treatments that ensure favourable long-term outcome. Yet, the optical treatment strategy for multi vessel CAD remains a controversial topic.

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Cardiology Diseases, Disorders and Syndromes

All over the world, the death rate continues to increase as a restul of cardiology diseases. It is one of the critical issues in the medical world. Researchers and experts continue to innovate new technology, accessories and infrastructures, to help the increasing number of patients with cardiology diseases. Some common heart diseases and conditions include high cholesterol, Heart Failure, Atrial Fibrillation, Coronary Artery Disease, Mitral Valve Prolapse Syndrome. To provide better medical treatment to patients and to find new ways of treating such diseases, renowned cardiologists and experts organize conferences and seminars and publish authentic reviewed articles and case reports in medical journals.

There are few heart surgeons who have expertise in Endovascular Surgery. These doctors perform major surgeries accessing many regions of the patient’s body and they try to give new life to the patient. The review articles and practice guides on Endovascular Surgery help thousands of professionals acquire a thorough knowledge about the field. Whether a cardiology professional belongs to the USA, UK or any other country, the professional can learn a lot from the authentic journals. The journals found on radcliffecardiology.com are published three times annually and contain theoretical discussions about cardiovascular subjects.

An important area covered by these journals includes original research on Peripheral Stenting and satellite symposia proceedings about Peripheral Stenting. Before any of the articles or case reports are printed in the journals, the expert team members ensure the accuracy of the content. The experts are selected for their clinical expertise and they provide reviews. These journals and conferences are a great source of information for the cardiology fraternity across the world. Many professionals, clinicians and physicians acquire detailed knowledge about medical treatment and surgery on heart problems through these articles and research papers.

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Participate in the Cardiologist Education Conference

Doctors go through essential cardiologist education training for many years to learn about medicine and heart surgery before they become heart surgeons. But, the number of the doctors in comparison to patients is few. As the number of heart patients is growing, researchers and expert cardiologists are working hard to provide essential Cardiologist education to professionals and health-providers to close the gap in the ratio of expert heart doctors to patients. Cardiovascular disease killed 17.5 million people in 2012, that is 3 in every 10 deaths and this is expected to rise to 23.3 million by 2030.

Indeed cardiovascular disease is a major issue around the globe. All over the world, many organizations organize seminars and conferences so that they can develop new solutions for controlling the disease. There are institutions that give opportunities to renowned speakers to share their research work on Coronary Stenting in seminars. Also, authentic articles and journals on Coronary Stenting are published so that more doctors learn about the latest innovations in the medical field.

With the help of reviewed articles and practice guidelines, many professionals gain knowledge of Drug-Eluting Balloon Angioplasty and get in touch with the latest information in their field. The practice guides, review articles and case reports are carefully checked by experts before being published in medical journals. Knowledge of Drug-Eluting Balloon Angioplasty experts share their views in the form of theoretical discussions and original research. The aim of publishing all such information in journals is to keep cardiologists up to date with recent research and guidelines and to successfully treat and manage as many heart patients as possible more quickly. The seminars and conferences provide intensive training forcardiologists and keep them updated about high-tech medical equipment and its usage.

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