Kauvery Hospital Chennai, a unit of Kauvery Group of Hospitals in Tamil Nadu, has successfully conducted a complex coronary angioplasty procedure using drug coated balloons (DCB) on a 74-year-old man. The team of cardiologists performed an image-guided procedure using DCB alone without adding new stents, with excellent outcome. This innovative technique eliminates the side effects of stenting and can be an effective alternative to stents for coronary angioplasty.
The individual visited Kauvery Hospital Chennai with recurrent chest pain and had previously undergone left main bifurcation stenting in 2018 from elsewhere. However, the coronary angiogram showed severe in-stent restenosis of both stents, i.e. re-narrowing in the stents placed earlier leading to narrowing of arteries.
Bypass surgery was one option to resolve the condition, but the individual refused to undergo the same. On the other hand, a repeat angioplasty using two more stents in the same site was deemed too risky, as it would result in multiple layers of stent and too much metal in that area, increasing the risk of stent clotting or restenosis.
DCB is a milestone and the fourth revolution in Percutaneous Coronary Intervention (PCI) therapy, after balloon angioplasty (1977), bare metal stents (1988), and coronary drug-eluting stents (2001). Unlike traditional stenting, where a metal stent is permanently inserted to enlarge a blocked artery, DCB releases a drug (Sirolimus) from the balloon surface within 60 seconds of inflation, eliminating the risks associated with stenting.
According to Dr K.P Suresh Kumar, Chief Cardiologist at Chennai Kauvery Hospital, DCB can replace stent usage in up to 25% of angioplasty procedures. "Today about 95% of angioplasty procedures use a metal stent to enlarge a blocked artery permanently. However, this can create stent related issues and the need to continue multiple blood thinning medicines for at least one year, with the risk of bleeding. Stenting & drug coated balloons are complementary and we can combine both in appropriate patients. We can eliminate all the side-effects of stent and the blood vessels even undergo positive remodeling. It can reduce the stent usage & preserve the normal function of the blood vessels. The concept can be extended to bifurcation stenosis where stenting of the main vessel and DCB to the smaller branches is a viable option. The Sirolimus drug-coated balloon available in India is called MAGIC TOUCH balloon, which has the largest data globally, and the US FDA recently approved this balloon," he said.
India, being the diabetes capital of the world has a major population with blocks in small caliber vessels and hence inserting a small diameter stent carries a high risk of restenosis. Drug Coated Balloons are best suited for the Indian population.