Coronary intervention · Kauvery Heart Institute, Radial Road
Complex and calcified blockages, including patients turned down for bypass surgery
Some blockages are hardened with calcium, completely closed for months, or spread through the main arteries, and some patients with them are not suitable for bypass surgery. With careful planning and specialised tools, angioplasty is often still possible.
Access
Usually the wrist artery
Anaesthesia
Local — you stay awake
Calcium tools
Rotablation · Laser · Lithotripsy
Hospital stay
Typically 1–2 days
When bypass surgery is not an option
Surgeons may advise against bypass surgery because of age, a weak heart muscle, lung or kidney disease, a previous bypass operation, or arteries too diseased to take a graft. Some patients simply do not want open-heart surgery. A careful review of your angiogram often shows that angioplasty is still possible.
The main aim is to relieve chest pain and breathlessness and let you return to an active life. In people with a weak heart but no chest pain, research shows that medicines alone can be just as effective, so we recommend angioplasty only when it is likely to help you, and we explain the expected benefit and the risks before any decision.
Why calcium makes angioplasty difficult
Calcium turns a soft blockage into something closer to bone. A standard balloon may not cross it or may not open it, and a stent squeezed by calcium stays narrow. An under-expanded stent is a leading cause of the artery narrowing again or clotting later. So in these arteries the calcium is treated first, and the stent is placed only once the artery can open fully.
The tools we use
Imaging inside the artery (IVUS / OCT)
A tiny probe measures the calcium and the artery size, and confirms the stent has opened fully. International guidelines now recommend imaging for complex angioplasty because it lowers the risk of future heart attacks and repeat procedures.
Rotational atherectomy (rotablation)
A diamond-coated burr spinning at high speed sands down hard calcium so that balloons and stents can pass and expand.
Laser atherectomy
Pulses of laser light through a thin catheter break up tough plaque. Useful when nothing else will cross a blockage, in long-standing total occlusions, and in old stents that have narrowed or failed to expand.
Intravascular lithotripsy
A balloon that sends sound-wave pulses to crack calcium deep in the artery wall, allowing the stent to expand.
Cutting, scoring and high-pressure balloons
Special balloons that score or break calcium in a controlled way before the stent is placed.
Chronic total occlusion (CTO) techniques
Specialised wires and microcatheters, sometimes working from a second artery, to open an artery that has been fully blocked for three months or more.
Drug-coated balloons
Deliver medicine to the artery wall without adding another layer of metal — useful for re-narrowed stents and small arteries.
Heart support during high-risk angioplasty
When the heart muscle is weak, a support device such as an intra-aortic balloon pump or Impella can help the heart during the procedure.
The tools used depend on your blockage and are chosen during planning; many cases need more than one.
Angioplasty or bypass surgery?
For some people — for example, those with diabetes and narrowing in all three main heart arteries who are fit for surgery — bypass surgery gives better long-term results. We review your angiogram openly, and when surgery is the better option we will tell you so and refer you to a cardiac surgeon.
What to expect
Consultation and angiogram review
Bring your angiogram CD and reports. Second opinions are welcome.
Planning
We study the angiogram in detail and decide the strategy, the tools, and whether treatment should be done in one sitting or two.
The procedure
At Kauvery Heart Institute, Radial Road, usually through the wrist while you stay awake. Complex procedures can take two hours or more.
Going home
Most patients go home within one to two days.
Medicines
Two blood thinners for a set period, along with medicines for cholesterol and blood pressure. Never stop blood thinners without speaking to your cardiologist.
Recovery and follow-up
A gradual return to activity, cardiac rehabilitation and regular clinic reviews.
Common questions
Is complex angioplasty safe if I have been turned down for surgery?
It carries more risk than a simple angioplasty. Possible complications include injury to the artery, a heart attack during the procedure, bleeding, kidney strain from the X-ray dye and, rarely, stroke or death. Your individual risk depends on your heart, kidneys and blockage, and we go through it with you and your family before deciding.
Will I feel the laser or the rotablation?
No. You are awake under local anaesthetic and do not feel the tools inside the artery. Some people notice brief chest discomfort while a balloon is inflated.
Will I need a stent?
Usually, but not always. Some re-narrowed stents and small arteries can be treated with a drug-coated balloon alone.
Is it worth opening a completely blocked artery?
Opening a CTO is done mainly to relieve chest pain or breathlessness that continues despite medicines. We will discuss the likely benefit and the risk for your particular blockage before deciding.
Questions about a complex blockage?
Book a consultation and bring your angiogram CD. We will review it with you and explain the options available.
SR Heart Clinic, Elangovan Street, East Tambaram, Chennai 600059 · Mon–Fri, 6:30–7:30 PM