Role of Imaging in Angioplasty – Dr M. S. Aditya

Role of imaging in Angioplasty:

What are the advances in the field of Coronary Angioplasty?

Coronary angioplasty for the past two decades has seen several advances. One of the important advances in recent times in the field of coronary artery imaging in this regard, the intravascular ultrasound, and optical coherence tomography have played an important role in optimizing our coronary angioplasty results.

What are the benefits of imaging angioplasty?

Over the past few years, the use of coronary angioplasty to treat coronary artery blockage has increased tremendously. This has set off a new set of challenges leading to more complex procedures and more complex interventions. Conventional angiography has been the gold standard of these but then conventional angiography suffers from certain limitations in terms of radiation exposure, in terms of dye load on the kidney, and also certain procedural issues leading to projection errors and underestimation and overestimation of the disease. These advanced modalities that are IVUS and OCT help us overcome some of these limitations. 

What is the technology behind these modalities?

Intravascular ultrasound or IVUS uses the principle of ultrasound technology to help us derive clear images of the coronary arteries. Here, ultrasound waves are passed through the vessel wall and the reflections are decoded by a catheter which is passed on to a machine for analysis. We get a vivid picture of the coronary artery from within the vessel itself. This helps us to understand the severity of the disease, the length, and extent of the disease, the diameter of the vessel, and the nature of the obstruction in several ways. Not only this, this modality does not involve any use of radiation or dye, it helps us to limit the use of Xrays and contrasts. 

Optical coherence tomography, on the other hand, uses light as a tool to study the vessels.

Here, light beams are focused on the vessel wall and the reflection is intermitted in terms of coherence, and tomographic pictures are generated from these images. We get very clear views from within the vessel wall, especially this is useful to understand how well our stent has deployed onto the vessel wall uniquely, tells us about the nature of the block material that is there helping us devise effective treatment solutions for these patients. Some of these patients may derive solutions from medical therapy also and prevent us from going for stenting. Some of these patients also benefit from more aggressive or more appropriate dilatation of the stent which allows for goof apposition to the vessel wall improving the overall result. 

Why is it important to consider imaging in angioplasty?

From treating the blocks, we are now focusing on optimal angioplasty, that is, we are not only treating the blocks we are also trying to see these blocks do not recur and not trouble the patient later in life. One of the most important determinants of having a good result in the long-term is achieving a good angioplasty result initially itself, so when we use these imaging modalities we can ensure that our results of angioplasty are optimum and that helps us to give a long term result for the patients, the most important derivative of doing coronary artery imaging is also, we study the vessels better with these modalities, we understand that the disease not lies within the vessel but in the vessel wall. We understand the disease process much better and this will probably help us to tailor our therapies for the future, and also in preventing heart attacks diseases in the future. 

Conclusion:

In conclusion, coronary angioplasty will remain the main stage for treating coronary artery blockages. In this regard, coronary imaging is an important aspect of angioplasty procedures. 

The use of coronary imaging in addition to angioplasty helps to optimize the results and get better long-term results and will also help us to understand the disease better. This will be the future of coronary angioplasty for the coming decades. 

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