Failed Angioplasty Treatment

The angioplasty procedure may fail if there is not sufficient disruption of the elastic fibers in the medial layer. Repeat angioplasty as treatment for restenosis is an effective approach associated with a high success rate, low incidence of procedural complications, and sustained functional improvement in combination with an acceptable rate of bypass surgery. Patients cannot have more than 5 to 6 stents.

Symptoms:

  • Chest pain
  • Fatigue
  • Sortness of breath

Diagnostic test: Stress test can help the doctor if a blockage as returned or if there is a new blockage

When do you need a stress test after a stent procedure

You may need a stress test if:

  • Your symptoms (chest pain, shortness of breath, or fatigue) come back or get worse.
  • Finding it harder to exercise or climb stairs.
  • Your doctor wants to check blockages that were not severe enough to treat when your stent was inserted. Your doctor can do this with a single test. You don’t usually need yearly tests.
  • You have had multiple heart procedures in the past, such as stents after a bypass surgery.
PTCA
  1. Failure of PTCA may results from inability to cross lesions with A guide wire
    • Balloon catheter
    • Inability to fully dilate a rigid lesion
  1. Laser balloon angioplasty (LBA), as first described by Spearsl , is a new technique that has been shown experimentally to be useful in the acute and chronic reduction of arterial recoil, treatment of arterial dissections and mechanical perforations, and desiccation of thrombus.
  2. Clinical trials of LBA for both successful and failed PTCA are ongoing.

Methods

Laser Balloon Angioplasty Catheter

LBA catheters have been designed to effect a radial dispersion of laser energy to the arterial wall during the final inflation of otherwise conventional  PTCA.

Laser Balloon Angioplasty Catheter
Balloon Angioplasty

LBA Technique and Protocol

  • During the course of LBA treatment for these studies, the guiding catheter was flushed with warmed physiologic saline while the balloon was inflated.
  • The laser was then activated for a duration of 20 seconds followed by a 20-30 second period to allow for tissue cooling prior to balloon deflation
  • Laser energy doses ranging from 240 to 450 joules were delivered in a ramped decremental fashion shown experimentally to result in increased strength of thermal welds.

Treatment Options for in-stent Restenosis

Re-Stenting

If an interventional procedure is needed, the approach will vary depending on if the original stent were fully expanded, how many stents are overlapped, and the length of the re-blockage.

Re-Stenting

Non Surgical Options

  • An IVUS or OCT can help check to see if either of those problems exist.
  • Sometimes the solution is simply re-expanding the stent. This can be done with a high pressure balloon.
  • If the stent was well-expanded and the problem is tissue regrowth inside the stent, the best treatment option is often placement of another drug-eluting stent (DES).
  • If 2-3 stents are already in place, we usually recommend brachytherapy or occasionally drug-eluting balloon use. Shorter blockages tends to respond better to all of these approaches

Supplementary Medications

  • Sirolimus can help reduce the amount of restenosis tissue that builds up.
  • The medication is sometimes prescribed for patients who have had restenosis more than twice in the same area.
Supplementary Medications
Medical Management

Medical Management

Surgery

  • Coronary artery bypass graft surgery uses blood vessels from other parts of the body.
  • The grafts come from the patient’s own arteries and veins in the chest, leg or arm.
  • Bypass surgery is a good treatment option for patients (especially patients with diabetes) who have coronary restenosis.

Long term antiplatelet therapy

  • Patients who have bare metal stents need to take antiplatelet medication for at least 4 weeks after the procedure.
  • Patients who have a drug-eluting stent need to take antiplatelet medication for at least a year after the procedure, and longer for high risk patients.

Life Style Changes

  • Follow a heart healthy diet
  • Control diabetes
  • Reach and maintain a healthy weight
  • Take all medications as prescribed
  • Quit smoking
  • Exercise regularly
  • Follow-up appointments
Life Style Changes

  • "Dr. Sharath Reddy is the best cardiologist in Hyderabad. We underwent the heart treatment under him. We are very happy with the treatment."

    SREE VATSAVA - HEART PATIENT

  • I would like to thank Dr Sharath Reddy and his team for the excellent cardiac care and treatment provided to me. I have been given all the information and advice to lead my life in a comfortable way after the procedure. I can’t thank you enough for all your time, hard work, and patience. I truly appreciate your caring dedication.

    Narayana E

  • My brother had severe dyspnoea (shortness of breath) and it was difficult for him to walk for even very small distances. He had severe pedal oedema (feet swelling) and was not able to do routine activities on his own. But after TAVI procedure he is able to breathe well and walk comfortably for small distances without any difficulty. Within a short time after the TAVI procedure he is performing his routine own activities. We are grateful to the cardiac team at Medicover Hospitals.

    Hanumantha Rao