The Hindu : Andhra Pradesh / Vijayawada News : Latest reperfusion and interventional therapies help save heart and brain

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Friday, Jul 01, 2005

Andhra Pradesh

Andhra Pradesh - Vijayawada

Latest reperfusion and interventional therapies help save heart and brain

Cardiovascular Diseases ( including heart attack, paralysis ) are the leading cause of death & disability worldwide in both developed and developing countries. Every year 20 million people are affected by these diseases.

Once a person sustains heart attack or paralysis the speed and completeness of revascularization dictate mortality and morbidity. The basic pathology lies in the vascular system — so called atherosclerosis leading to progressive clogging of the blood vessels - some times leading to complete block causing the death of the tissue supplied. If it happens in the heart it is called heart attack (Myocardial infarction). The same process occurs in the brain leading to paralysis (brain stroke). The treatment is aimed at reperfusion ( restoration of blood flow ) as early as possible before the tissue suffers irreversible damage.

This is done in three ways

1) Intravenous Thrombolysis , 2) Intra arterial thrombolysis, 3) Mechanical Interventions (balloon angioplasties, stent, neurojet etc.,)

For heart attack patients IV Streptokinase, Urokinase, rtPA are used routinely. They are effective in 60% to 70% of the cases only. Bleeding complications are relatively common, some times life threatening, not all patients are eligible for this therapy (patients with recent non cardiac surgery, recent brain strokes bleeding peptic ulcer patients etc.,).

So the best choice of treatment for emergency acute heart attack is Primary Angioplasty because of very high success rate with least complication rate.

Angioplasty procedure involves passing a guiding catheter till the origin of the blocked coronary artery and through this a fine guide wire is passed across the obstruction. Over the wire balloon is passed. With the expansion of the balloon the obstruction gets relieved. To prevent recurrence of obstructions routinely now a days stents are being used. Stent is a spring like structure made of metals like platinum, gold, stainless steel, tantalum etc., The stent is placed at the site of obstruction so that it prevents blood vessel from reocclusion. The latest drug eluting stents have very minimal restenosis rates. The whole process of angioplasty takes 30 minutes to 60 minutes and results are very gratifying. However, it also has some limitations as it requires full fledged cardiac cath lab with round the clock availability of the whole team, technical expertise, backup facilities like availability of all the emergency latest medicines, biochemistry lab etc., Further advancement in the techniques is Trans radial catheterization that is performing the angio procedure through the wrist -radial artery, which minimize the vascular complications and improves the comfort to the patients with early ambulation.

Similar developments occurred in ischemic brain stroke treatment. When a patient with paralysis symptoms is brought to the stroke unit with in three hours onset. IV rt PA thrombolytic therapy can be given. It lyses the clot (clot buster drug ) restores blood flow and saves brain. The patients can make dramatic recovery, some times reaching normalcy with in 24 hours. There is a 6% risk of hemorrhage in the brain. When the patient is brought after three hours of onset of stroke symptoms, intra arterial thrombolysis can be tried. In this, the patient is taken to the cath lab, emergency brain angiogram is done and a drug called urokinase is injected directly in to the intra cranial blood vessels through micro catheters. Some times a balloon is used to dilate the blocked vessels in the basilar system. All these procedures are time bound therefore the patient and attendants should recognize the symptoms and rush to the emergency hospital as early as possible to have the best effect.

All the above treatments requires Neurologist, Neuro surgeon, Radiologist, acute coronary team, interventional cardiologist and cath team, stroke unit, CT scan with round the clock availability.

Primary angioplasty in emergency heart attack patients, Trans radial procedures, interventions, rtPA Intravenous and Intra arterial thrombolytic therapy to brain strokes are regularly done in suitable patients with high success rate in Lalitha Super Speciality Hospital.

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