Making complex heart procedure like child’s play

Technology is really advancing at such a rapid rate, and modern medicine is certainly benefiting a lot from it, making complex procedures seemingly like child’s play.

In the recently concluded European Society of Cardiologists in Rome, Italy, more than 30,000 heart specialists and scientists gathered from around the world to share new findings and innovative technologies which can improve the treatment of heart diseases.

One of the invasive imaging techniques which doctors were excited to know more about was the so-called optical coherence tomography (OCT) which can clearly visualize the heart’s coronary arteries in patients undergoing angioplasty or percutaneous coronary intervention (PCI). This is a procedure which can restore the blood circulation by dilating (without bypass surgery) the coronary arteries that are already significantly occluded by atherosclerotic plaques consisting of fats and blood elements.

With the use of OCT, outcomes of PCI, which is commonly done in our country, are more successful and favorable on the long term, compared to standard angiography-guided PCI, which is the one commonly used now.

Useful additional info

The study, with the acronym Doctors (Does Optical Coherence Tomography Optimize Results of Stenting?), showed that in patients with a heart attack requiring immediate PCI, OCT “provided useful additional information beyond that obtained by angiography alone, and impacted directly on physician decision-making,” explained Nicolas Meneveau, MD, PhD, the study’s lead author from the University Hospital Jean Minjoz, in Besançon, France.

When using OCT, the heart specialist doing the PCI introduces an imaging catheter into the coronary artery to determine the size of the clogged heart arteries, characteristics of the blockage, plus other vital data; and these information may help guide the doctor to “change procedural strategies in half of cases,” said Professor Meneveau. He added though that “additional prospective randomized studies with clinical endpoints are required before it can be recommended for standard use.”

The Doctors study was a well-designed multi-center trial which enrolled 240 heart attack patients who were randomized and assigned 1:1 to standard fluoroscopy-guided PCI alone (angio group) or with the addition of OCT, which was performed an average of 3.8 times, before, during and after the procedure.

With better outcome

Overall, the results with the use of OCT was associated with better outcome than PCI guided by fluoroscopy alone, said Professor Meneveau.

One of the parameters used in the study was fractional flow reserve (FFR), which is a measure of blood flow and pressure in the heart artery before and after the PCI procedure. The FFR was significantly better in the OCT group as compared to the angio group. Likewise, the number of patients with a post-procedural FFR considered to be very good was significantly higher in the OCT group.

Compared to angiography, OCT also allowed the clinicians attending to the patient to determine the nature of the obstruction—whether it’s more due to blood clot (thrombus) or more calcifications due to the slow, gradual process of atherosclerosis.

Less complications

If it’s more due to blood clot, the clinician can administer potent blood thinners to dissolve or minimize the clot. The clinician is also guided on other aspects that could make the PCI more successful with less complications on the long term. Problems like malapposition or bad positioning of the implanted stents were seen in a third of cases in the study; hence, it was prevented. Stents are the mesh wire implanted after dilating the occluded arteries to serve as ’scaffolding.’ Stent malapposition is generally not visible under the standard X-ray fluoroscopy currently being used.

Although the addition of OCT increased procedure time of the PCI, as well as the patients’ exposure to fluoroscopy and the dye used which served as contrast medium for the X-ray, this did not increase complications such as peri-procedural heart attack or impaired kidney function, assured Professor Meneveau.

The use of OCT can really simplify what is actually a technically difficult procedure, which PCI is. It can provide some sort of a panoramic angiographic “mirror” which can address many of the blind spots heart specialists who do PCIs commonly encounter.

For patients undergoing PCI, especially those with an acute heart attack, it’s reassuring to know that their heart specialist has all the technical support needed to make the procedure optimally successful and ensure favorable outcomes, both on the short and long terms.

But it’s still best to maintain a healthy lifestyle and heed our doctors’ instructions so we can prevent a heart attack, and not have any need for PCI or OCT.