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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Cardiology Conferences aim to educate professionals

Cardiovascular disease is the world’s biggest killer. An estimated 17.3 million people died from CVDs in 2008 and this is believed to increase to more than 23 million people in 2030. Controlling these numbers is thus a major challenge and why major institutions and universities around the globe are working tirelessly to find new treatments. They organize cardiology conferences for professionals to share and discuss innovations in the field and provide delegates with information about recent research so that they can learn new ways of treating heart patients. In the world cardiology conferences, renowned speakers and reputed authorities gather to share findings and trial results to help medical practitioners learn about new innovations in cardiology.

Thousands of health-providers participate in these international seminars and receive new insights from cardiology journals and articles. Experts on Embolic Protection share their views and explore how heart surgeons can use carotid angioplasty in patients to save many lives. Embolic Protection devices are used to remove debris from cardiovascular disease patients. These seminars provide wide and deep knowledge about the latest treatment through papers written by researchers and experts. 

Above all, medical information centers work incessantly in innovating new and easy ways of treatment so that expenses and the surgery time can be reduced. There are many recognized experts who published their articles and papers on Fractional Flow Reserve (FFR). They spend years in research to find the Fractional Flow Reserve (FFR) technique for measuring the pressure difference in coronary catheterization. Some practitioners are slow to learn about advances in mediacal treatments for heart patients and they continue applying traditional techniques. In these cases, research papers, journals and provide them a thorough knowledge about recent treatments. 

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Is CABG getting safer?

Stroke is one of the most devastating complications after coronary artery bypass graft (CABG) surgery, entailing permanent disability, a 3–6 fold increased risk of mortality, an incremental hospital resource consumption and a longer length of hospital stay. Notwithstanding advances in surgical, anaesthetic and medical management across the last 10 years, the risk of stroke after coronary artery bypass graft (CABG) has not significantly declined, likely because an older and sicker population is now deemed suitable to undergo CABG. 

Advances in endovascular surgery have meant that whilst traditional "open heart" procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries. "Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other endovascular surgery procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), increasingly are being used. 

Risk stratification is of the utmost importance for identifying vulnerable patients. Specifically, pre-existing cerebrovascular disease and atherosclerosis of the ascending aorta are major determinants of the risk of peri-operative stroke, and should be always carefully scrutinised. RCTs and meta-analysis do not clearly support routine implementation of offpump CABG as a strategy to minimise the risk of stroke. Observational studies have suggested that anaortic approaches might reduce the risk of stroke compared with conventional CABG in patients with severe atherosclerosis of the ascending aorta. Further randomised controlled trials are warranted to confirm this hypothesis. Heart stenting is another option for treating patients with CABG. The clinical application of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) is still controversial. The need for repeat revascularization is significantly lower with CABG, but the risk of stroke is significantly higher, a trade-off that must be taken into account when considering heart stenting for patients with advanced coronary disease.

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