Fortis Mohali Leads in Advanced Angioplasty for High-Risk Elderly Cardiac Patients

Fortis Hospital Mohali is one of the leading centres of excellence in cardiac care, The hospital offers cutting-edge interventional cardiology treatment to high-risk patients who were earlier considered unfit for bypass surgery or angioplasty.

A 93-year-old man with complex  heart disease and weakness was successfully treated with an advanced form of angioplasty for a major heart artery blockage. In another case, a 70-year-old man with diabetes, heart failure, kidney problems, and blockages in three heart arteries also underwent a complex and risky angioplasty. Both patients were not fit for surgery, but thanks to advanced technology and expert medical care, they have recovered well and are doing fine.

Giving details, Dr Sudhanshu Budakoty, Senior Consultant, Department of Cardiology, Fortis Hospital Mohali, said, “A 93-year-old man with diagnosed hypertrophic cardiomyopathy (thickening of the heart wall, especially the left side), coronary artery disease presented to us with chest pain. He had undergone coronary angiography in 2022 and was advised for CABG (Coronary Artery Bypass Graft), but due to his advanced age and frailty and possible high-risk surgery he did not go for it and was kept on medical management.”

 Despite of all optimized medical treatment, he continued to have recurrent chest pain at rest. The doctor discussed the treatment options with the patient and family and counseled them about the need for repeat angiography. The patient and his family were unsure at first, as they had previously been told that neither surgery nor stenting was an option. Dr. Sudhanshu explained to them the need for intervention now and if required stenting is possible. He was taken up for Coronary Angiography (CAG), which showed calcified triple vessel disease.

The calcified vessels could not be stented without plaque modification. The patient and his family were explained the advanced treatment options to deal with the hardened calcium in his heart arteries. These included special techniques like Rotablation, Intravascular Lithotripsy (IVL), and Laser, followed by placing a stent in the artery causing the symptoms. After they understood everything and gave written permission, the patient underwent a complex angioplasty using the IVL method, in which gentle shockwaves are sent through a balloon to crack and soften calcium in the artery walls.

The patient had an angioplasty (PCI) done in one major artery – LAD (the most important artery in the front of the heart supplying maximum myocardial tissue). Patient was stable post procedure and was discharged the next day with no chest pain. He was followed up in OPD with no residual symptoms.

Dr Sudhanshu Budakoty  further added, “In another similar case, A 70-year-old diabetic man presented to us for cardiac clearance of surgery for anal fistula. On routine evaluation, we found out that he had a previous suffered a silent heart attack and it caused his heart pumping to drop to 30%. He was also detected with possible chronic kidney disease. In view of his high-risk conditions, he was first taken up for CAG which showed diffuse triple vessel disease with calcification in all 3 arteries with very poor flow in distal vessels making bypass surgery a difficult choice. Patient and family were counseled regarding the nature of disease and high-risk procedure of revascularization in view of low ejection fraction, diabetes, kidney disease and calcified vessels. They were not willing for bypass surgery at this age and hence a decision for high-risk angioplasty with IVL assistance for calcium modification was taken.”

IVL was done to treat blockages in the left main and LAD (a major heart artery). Two stents were placed from the left main to the LAD to keep the arteries open. A very small amount of dye was used during the procedure to protect the patient’s kidneys. The patient remained stable after the procedure and was safely discharged the next day, Dr. Sudhanshu added.