#ivl

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PACE Hospitals’ expert cardiology team successfully performed a Percutaneous Transluminal Coronary Angioplasty (PTCA) of the mid-left anterior descending (LAD) artery using Intravascular Lithotripsy (IVL) and Intravascular Ultrasound (IVUS) guidance in a 44-year-old male with severe coronary artery disease. The procedure aimed to relieve a critical arterial blockage, restore adequate myocardial blood flow, and improve cardiac function, thereby reducing the risk of further ischemic damage.

At PACE Hospitals, we understand the importance of a healthy heart and are committed to being the Best Heart Hospital in Hyderabad, Telangana, India. With cutting-edge technology, 24/7 emergency heart care, and personalized treatment plans, we ensure the best outcomes for our patients.

Recognized among the Top Cardiology Hospitals in Hyderabad, Telangana, India, our Department of Cardiology is equipped with the Philips Azurion Cardiac Catheterization Laboratory (Cath Lab), offering advanced diagnostic and interventional procedures for a wide range of heart diseases and cardiology conditions.

☑️ Past Medical History

The patient is a known case of chronic liver disease (CLD – compensated, Child-Pugh Class A) with pancytopenia secondary to splenomegaly. He also has a history of type 2 diabetes mellitus, for which he is on regular medication.

On Examination

On examination, the patient was conscious, cooperative, and oriented. There was no pallor, icterus, cyanosis, or pedal edema. Vital signs were stable. Cardiovascular examination revealed normal heart sounds without murmurs. Respiratory examination showed clear bilateral breath sounds with no added sounds. The abdomen was soft and non-tender, with palpable splenomegaly but no ascites. Neurological examination was normal, with no focal deficits noted.

☑️ Diagnosis

Upon admission to PACE Hospitals, the patient was evaluated by the cardiology team, which included a detailed review of his medical history and a comprehensive clinical examination. Holter monitoring revealed non-sustained ventricular tachycardia (NSVT), prompting further cardiac evaluation.

The patient underwent a comprehensive diagnostic evaluation to assess cardiac status. Coronary angiography (CAG) confirmed Single Vessel Disease (SVD) with a 90% calcified stenosis in the mid-left anterior descending (LAD) artery. Additional imaging with intravascular ultrasound (IVUS) and intravascular lithotripsy (IVL) was used to guide intervention. Echocardiography findings indicated preserved left ventricular function.

☑️ Medical Decision Making

After a detailed consultation with Dr. Seshi Vardhan Janjirala, Consultant Interventional Cardiologist, and Cross- Consultations with Dr. Govind Verma Interventional Gastroenterologist, and Dr. Tripti Sharma, Consultant Endocrinologist, a comprehensive multidisciplinary evaluation was carried out to develop an appropriate diagnostic and therapeutic plan tailored to the patient's complex clinical condition, which included coronary artery disease (CAD), chronic liver disease (CLD – compensated), and type 2 diabetes mellitus.

Considering the patient’s symptoms of chest pain, dizziness, and syncope, along with holter evidence of non-sustained ventricular tachycardia (NSVT) and coronary angiography findings of a 90% calcified stenosis in the mid-left anterior descending (LAD) artery, it was determined that percutaneous Transluminal Coronary Angioplasty (PTCA) with stent placement to the left anterior descending (LAD) artery with Intravascular Lithotripsy (IVL) and intravascular ultrasound (IVUS) guidance was identified as the most effective intervention to restore coronary blood flow, relieve ischemic symptoms, while ensuring that hepatic and metabolic comorbidities were concurrently managed.

The patient and his family were informed about his diagnosis, the planned procedures, associated risks, and the expected benefits to preserve heart function and enhance his overall prognosis.

☑️ Surgical Procedure

Following the decision, the patient was scheduled to undergo Percutaneous Transluminal Coronary Angioplasty (PTCA) Procedure in Hyderabad at PACE Hospitals, with stent placement to the left anterior descending (LAD) with Intravascular Ultrasound (IVUS) and Intravascular Lithotripsy (IVL) guidance.

The procedure involved the following steps:

🔹 Vascular Access and Coronary Angiography: Vascular access was obtained via the radial artery under aseptic precautions. A guiding catheter was advanced to the coronary ostium, and coronary angiography confirmed severe calcified stenosis in the mid-LAD.

🔹 Guidewire Advancement and IVUS Assessment: A coronary guidewire was carefully navigated across the LAD lesion. IVUS was performed to evaluate the vessel diameter, plaque burden, and lesion length, which guided the stent selection and sizing strategy.

🔹 Intravascular Lithotripsy (IVL): Due to heavy calcification, IVL was employed to fracture the calcified plaque and improve vessel compliance, enabling safer and more effective stent expansion.

🔹 Balloon Pre-Dilation: The lesion was pre-dilated using a balloon catheter to prepare the vessel for stenting. This step helped in facilitating optimal deployment of the stent.

🔹 Stent Deployment: A drug-eluting stent was deployed in the mid-LAD under IVUS and fluoroscopic guidance. The stent was expanded appropriately, restoring coronary lumen patency.

🔹 Post-Deployment Imaging and Hemostasis: Final imaging with IVUS and angiography confirmed excellent stent apposition and flow restoration without complications. Hemostasis at the access site was achieved, and the patient was transferred to the cardiac care unit for post-procedure monitoring and initiation of medical therapy.

☑️ Why Choose PACE Hospitals

PACE Hospitals — Best Hospital in Hyderabad, Telangana, India, stands out as a premier center for advanced cardiac interventions, including PTCA with IVL & IVUS for complex and calcified coronary artery lesions. Recently, the hospital successfully treated a 62-year-old male patient with a heavily calcified LAD lesion, achieving optimal stent expansion and restoring normal blood flow. The hospital’s approach integrates:

✅ Advanced diagnostics with Intravascular Ultrasound (IVUS) for precise lesion assessment and procedural guidance

✅ Cutting-edge treatment using Intravascular Lithotripsy (IVL) to modify calcified plaque and ensure successful stent deployment

✅ Expert interventional cardiology team with extensive experience in complex coronary procedures

✅ Comprehensive cardiac care—from pre-procedure evaluation to post-procedure follow-up—ensuring long-term heart health

👉 Learn more about this case: PTCA with IVL and IVUS Guidance for Calcified LAD

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