Barostim Therapy & Cardiovascular Health

Whenever there is an obstruction or blockage in the coronary arteries, it hinders the oxygen-rich blood flow to the heart muscles, resulting either in angina (chest pain) or myocardial infarctions (heart attacks). In some cases, the blockage occurs more slowly so that collateral circulation starts to take up the role of coronary arteries. In medical terms Coronary chronic total occlusion is defined as – “a complete blockage of the coronary artery with TIMI (Thrombolysis in Myocardial Infarction) zero flow present for an estimated duration greater than or equal to three months”. Chronic Total Occlusion (CTO) is often found in patients with significant coronary artery disease (CAD), presenting a management dilemma for interventional cardiologists.

Coronary artery chronic total occlusion which occurs due to the deposit of fibrocalcific plaque is one of the most commonly identified lesion subsets in CAD patients. Revascularization of CTO can offer varied benefits as it provides improved heart function and reduced risks of arrhythmic events. Intricate pathophysiology of organized fibrocalcific atherosclerotic plaque which makes it difficult to cross with guide –wire increases the complications of percutaneous approach for CTOs. A promising solution to this guide-wire problem was the delivery of radiofrequency energy through the catheter guide wire that can burn off the blockage. Similar to the novel latest Thermocool Smarttouch Catheter, this method allows the interventional cardiologist to ablate the atherosclerotic plaque without causing any injury to the wall of the coronary artery. As the latest Thermocool Smarttouch Catheter is mainly used during the cardiac ablation procedure, the safe-cross-guided radiofrequency total occlusion crossing system allows the physician to clear out the CTO blockage to perform percutaneous coronary intervention (PCI). 

Another risk factor that can increase the chances of major acute cardiovascular events among the CAD patients is the presence of resistant hypertension. As the name implies, it is a medical condition when the blood pressure remains stubbornly high despite medical treatment. Promising results from the novel barostim therapy presents new hope to the medical community. Reducing the excessive blood pressure and improving cardiovascular function by a great extent, barostim neo implantation and therapy is projected to be an ideal choice for treating resistant hypertension. Novel barostim therapy can reduce the likelihood of adverse cardiovascular events thereby improving the quality of life. 

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Stenting For Multivessel Coronary Artery Disease

Hardening of arteries (atherosclerosis) not only causes lesions in the blood vessels but also results in the obstruction of blood supply to the heart muscles. During strenuousactivities, narrowed coronary arteries won’t be able to supply enough blood to the myocardium leading to angina (chest pain). Coronary artery disease (CAD) can be fatal as it is a major cause of heart attacks (myocardial infarction). CAD  can also lead to disability and decreased quality of life. Managing coronary heart disease has always been a challenge to cardiologists due to the increasing complexity of lesions and location of stenosis. Symptomatic Multivessel coronary artery disease that affects two or more epicardial vessels is a case in point. Optical therapeutic approach for treating multivessel disease (MVD) is still a point of fervent discussion within the medical community.

There are mainly three treatment modalities available for patients with MVD which includes medical therapy, non-invasive percutaneous coronary intervention (PCI)and coronary artery bypass graft (CABG) surgery. Though bypass surgery was a preferred approach over stenting in MVD treatment, the recent advancements in catheterization procedures and technologies have reignited an interest in percutaneous intervention. Drug eluting stenting (DES) has proven successful in overcoming the adverse clinical outcomes of bare metal stenting (BMS) by a greater extent.  Moreover, widespread application of fractional flow reserve measurement technique has made it easier for physicians to choose between the non-invasive percutaneous coronary intervention and pharmaceutical treatment for a CAD patient. As per the famous FAME study, it has been proved that FFR guided percutaneous approach can ensure better outcomes in managing the symptomatic multivessel coronary disease. Followed by that, the FAME 2 study results demonstrated PCI along with medical therapy can ensure better outcomes when compared to medical therapy alone.

Innovative advancements in the cath lab set up and interventional environments have been helping physicians to perform both interventional and surgical procedures with great accuracy and precision. For example, Philip’sXper Flex Cardio equipped with multiple functionalities aids physicians in treatment decisions. This hemodynamic cardiac monitoring system supports FFR measurements and provides 16-lead ECG analysis, culprit Artery detection and patented ST maps. Philip’s Xper Flex Cardio system and similar physiomonitoring systems can surely enhance the efficiency on multiple levels.

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FFR-Guided Percutaneous Coronary Intervention Gain Advantage Over Medical Therapy

Coronary heart disease also known as ischemic heart disease can be described as a condition where the coronary arteries are severely narrowed because of atherosclerosis. When the heart muscle is starved of oxygen and nutrients, it induces chest pain (angina). However, in some cases there is a complete blockage in blood supply leading to heart muscle damage and myocardial infarctions (heart attacks). Some of the common symptoms of coronary artery disease (CAD) to watch out for include chest pain, nausea, dizziness and shortness of breath. It is advisable to seek medical treatment immediately before the symptoms turn severe and frequent. Remarkable advances in the diagnostic procedures, standard blood flow measurement techniques and medical imaging devices have been helping cardiologists to evaluate CAD in a better way.

Angiography is the first-line diagnostic investigation recommended by cardiologists. Having a detailed physiological analysis of stenosis in the arteries is essential to choose between the varied treatment options – pharmaceutical therapy, FFR-guided percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.  However, several studies and clinical trials have pointed out the limitations of coronary angiography in estimating the degree of luminal narrowing. Standard blood flow measurement techniques and imaging tools can provide a detailed visualization of the blood flow and performance of the heart.  Fractional Flow Reserve (FFR), as a case in point, assists the physicians in identifying the ischemic and non-ischemic lesions. Results published by the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study demonstrated the superiority of FFR over angiography in deciding whether or not to stent the lesions. Moreover, it has been proved that FFR-guided percutaneous coronary intervention assure better outcomes and significantly lower complication rates.

Medical therapy was considered to be the best approach for patients with stable CAD and significant stenosis. Results from the latest FAME 2 trials conclude that FFR-guided drug-eluting stenting (PCI) is superior to medical therapy for managing stable coronary disease. Two year data from FAME 2 trials shows a great reduction in the major adverse cardiac events and decrease in the risk of urgent revascularization. As per the latest FAME 2 study results, FFR-guided PCI plus optimal medical therapy shows sustained clinical and economic benefits when compared with medical therapy alone.

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Treatment of Coronary Bifurcation Lesions

Interventional cardiology has been witnessing technological advances and improved success over the last decade. Increasing success and safety levels of interventional cardiac procedures has improved the outcomes for patients with coronary artery disease (CAD). An underlying pathologic process called atherosclerosis can make the coronary arteries lose their flexibility and elasticity over time. Plaque build-up causes the artery to narrow thereby impairing the blood flow to the heart tissues. One of the common coronary heart disease symptoms is chest pain or discomfort accompanied by shortness of breath. In most cases, the pain may occur during physical or emotional stress. Early diagnosis and treatment is the best way to tackle heart disease and live a quality life. That is why it is often advised to seek immediate medical attention when faced with common coronary heart disease symptoms.

Advanced diagnostic techniques and therapeutic approaches are available for detecting and treating CAD conditions. Percutaneous coronary intervention (PCI) with its minimally invasive procedure and reduced complication rate has superseded Coronary Artery bypass Grafting (CABG) in the treatment of single vessel CAD. Despite the advancements in stent technology and catheterization tools, interventional cardiologists find it a challenge to treat some complex coronary lesions that are often associated with higher restenosis, worse outcomes and greater complication rates. Complex bifurcation lesions are a case in point. When defined in medical terms, coronary bifurcation lesions can be defined as – “a lesion ≥50% diameter stenosis involving a main branch and/or contiguous side branch with a diameter of ≥2.5 mm”. Around 15% to 20% of the CAD lesions are bifurcation lesions, which present a challenge to interventional cardiologists.  Even though coronary angiography is considered as the gold standard for diagnosing heart ailments, angiographic evaluation alone can’t provide substantial information about the stenosis.

Innatelimitations of coronary angiography were a major concern in devising a right risk stratification approach for the complex lesions. Moreover, plain balloon angioplasty and bare metal stenting results were suboptimal because of the high rates of restenosis. But with the introduction of fractional flow measurement, advanced medical imaging methods and bioabsorbable drug eluting stent technology, percutaneous treatment of complex bifurcation lesions seems possible. Several studies and clinical trials are going on with the objective to address concerns related to stenting, and will hopefully hold the key to the successful treatment of bifurcations.

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Fractional Flow Reserve Measurement For Assessing Coronary Stenosis

Coronary Heart Disease which occurs as a result of atherosclerotic plaque-build up in the inner walls of coronary arteries is a common heart ailment that has been affecting millions of people worldwide. The field of cardiac science and interventional cardiology has been striving hard to devise an optimal approach to manage coronary artery disease (CAD).  Evaluating the physiological significance and severity of lesions is a challenging factor in most cases which is why pressure-based Fractional Flow Reserve measurement method was introduced. FFR provides a well-validated index in deciding between coronary stenting and medical therapy. Thses days, it is considered an indispensable clinical tool in the catheterization laboratory.

Pressure-based Fractional Flow reserve measurement provides the ratio of normal blood flow to the maximum achievable blood flow in the same coronary artery, given the maximal vasodilated condition. Lesions that measure a FFR value of less than 0.75 need percutaneous coronary intervention (PCI) with stenting, while lesions of a value higher than 0.75 should be managed with pharmacological treatment. Minimally invasive FFR technique possesses several special features that make it a gold standard for diagnosis in the catheterization laboratory. A well-defined cut-off value, unequivocally normal value for every patient and narrow gray zone are some of the major characteristics. Fluoroscopy guided pullback pressure recording performed during the catheterization proves to be a great tool in obtaining detailed spatial information and evaluating the hemodynamic effect of stenoses. The sensor placed in the distal coronary artery during FFR procedure is simply pulled back under fluoroscopic guidance to measure the pressure levels across the blood vessel. Helping the interventional cardiologist to assess the extent of lesions and exact location of the pressure drop, fluoroscopy guided pullback pressure recording proves to be a great diagnostic tool for different patient subsets.

Bifurcation lesions that involve the proximal main vessel, the distal main vessel and the side branch are one of the most challenging lesion subsets. Associated with restenosis, greater complications and lower success rates, severe coronary artery bifurcation lesions pose a major challenge for the interventional cardiologists. PCI is not considered as a favourable approach to treat the symptomatic coronary artery bifurcation lesions. However, with the advent of fractional flow reserve method and pullback pressure measurements, FFR guided PCI assures excellent results and safer outcomes.

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