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Coronary - Angiogram and Angioplasty.

Coronary - Angiogram and Angioplasty.

A coronary angiogram is a diagnostic procedure to ascertain if there is any blockage in heart arteries ( coronary artery disease- CAD ), using a dye and imaging techniques. Angioplasty is a treatment for opening the blockade in the coronary artery by inserting a short wire mesh tube, called a stent to open a narrowed or blocked artery in the heart without an open heart surgery. A coronary angiogram is also called cardiac catherization. Coronary artery disease may cause a heart attack or even heart failure if not treated in time. Get a coronary angioplasty in India with the best intervention cardiologist at top cardiology hospitals in India at the most affordable cost.

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Coronary angioplasty or Heart stent (PTCA/PTCI) for coronary artery disease (CAD):

A Coronary angiogram is a diagnostic procedure performed by a trained Intervention cardiologist to ascertain if there are any blockages in the arteries of the heart ( Coronary Artery disease ) and to look for any abnormalities in heart muscles or heart valves. A coronary angiogram is also called cardiac catheterization. A percutaneous transluminal cardiac angioplasty (PTCA) or heart angioplasty is the treatment for opening up the blocked coronary artery and restoring the reduced blood flow to heart tissues without open heart surgery. The procedure is also called percutaneous transluminal cardiac angioplasty ( PTCA). At CMCS Health, we are associated with the world's best intervention cardiologists at Top cardiology hospitals for cost-effective coronary angiograms and coronary angioplasty (PTCA).

 

Reason for a coronary angiogram or angiography:

A coronary angiogram is recommended because of the following symptoms and observations of an attending clinician.

  • An unexplained chest pain (angina pain) on the left side that travels to the left arm. Angina pain is because of reduced blood flow to tissues of the heart due to blocked coronary arteries. The major reason for angina is coronary artery disease ( CAD).
  • An abnormal electrocardiogram ( ECG ).
  • A Known history of congenital heart defect.
  • Irregular results of a stress test ( either on a treadmill also called TMT) or dobutamine-induced stress Echocardiogram.
  • A known blood vessel problem.
  • A known heart valve disease that may need surgery.

Coronary artery disease (CAD):

Coronary artery disease ( CAD ) is a damage or blockade of the coronary arteries which are the heart's major blood vessels. Coronary heart disease is also called ischemic heart disease or coronary heart disease. A major reason for coronary artery disease is high cholesterol and the building of plaque that narrows the coronary arteries. Coronary artery disease is observed because of the complaint of chest pain(angina) and subsequent diagnostic tests including coronary angiography or coronary angiogram. If not treated in time coronary artery disease may cause abnormal heart rhythm, a heart attack, or even heart failure. There are different treatment options for different patients with coronary artery disease.

Coronary artery disease types:

There are two major types of coronary artery disease. 

Stable ischemic heart disease:

Stable ischemic heart disease develops over some time and a patient may not have any symptoms in the beginning. As it is developed over a period it is also called chronic heart disease. The blockage of coronary arteries of the heart takes years before the patient has angina or other symptoms.

Acute coronary syndrome:

Acute coronary syndrome is a medical emergency and needs immediate medical intervention.  At times the plaque accumulated in the coronary arteries of the heart suddenly ruptures and forms a blood clot. This blood clot can move through the bloodstream and completely block the blood supply to the heart thereby causing a heart attack. 

Signs and symptoms of Coronary Artery Disease:

The primary reason for coronary artery disease is plaque buildup in the blood vessels. It is also called stenosis. The plaque buildup in the luminal of the coronary artery takes several years and in some cases decades. Initially, the patient with coronary artery disease may not feel any symptoms but as the coronary artery luminal gets narrowed the heart needs to pump harder to deliver oxygen-rich blood to tissues of other organs of the body.  The major symptoms experienced by CAD patients are:

  • Stable angina
  • Difficulty in breathing after a little exercise or physical activity.

Cause of coronary artery disease:

Atherosclerosis is a gradual buildup of plaque in arteries throughout the human body. When plaque buildup takes place in the coronary artery of the heart, it is called coronary artery disease. When plaque builds up in coronary arteries, it clogs the coronary arteries and as a result, heart muscles are devoid of enough blood. When the heart muscles do not get adequate oxygenated blood, it causes myocardial ischemia or coronary artery disease. Myocardial ischemia causes angina and increases the risk of a heart attack.

Complications of coronary artery disease:

Coronary artery disease takes place because of the clogging of coronary arteries with plaque. Over a period the coronary arteries get damaged, become stiff, and are not able to provide adequate oxygenated blood to heart muscles. As the heart muscles are devoid of adequate oxygenated blood and nutrients, they start dying gradually and may cause a heart attack. It is a medical emergency and needs prompt medical intervention, either a coronary angioplasty (PTCA) or a bypass heart surgery ( CABG ) to restore blood flow to heart muscles.

Other complications of coronary artery disease may be:

  • Abnormal heartbeats ( Arrhythmias )
  • Cardiogenic shocks
  • Cardiac arrests
  • Heart failure

Diagnosis of coronary artery disease:

When a patient complains of unexplained chest pain on the left side that radiates to the arm doctor will do a physical examination with blood pressure monitoring and take the family history and medical history of the patient. Heart specialists may also recommend the following cardiac evaluation tests for the patient:

  • Blood tests
  • Chest X-ray
  • An electrocardiogram ( ECG / EKG )
  • Coronary calcium scan
  • Echocardiogram
  • Exercise stress test
  • Computed tomography coronary angiogram
  • Invasive but confirmatory Coronary angiogram or angiography

Coronary Angiogram:

A coronary angiogram is done as a confirmatory test when all the noninvasive diagnostic tests suggest that the patient may have coronary artery disease. A coronary angiogram is performed in a cardiac catheterization laboratory ( Cardiac - cath. lab.) by an experienced intervention cardiologist. A coronary angiogram is done as a daycare procedure under local anesthesia. A coronary angiogram is usually done through two sites.

  • Near the wrist ( Radial artery )
  • Or Near the groin region ( Femoral Artery )

While performing a coronary angiogram, the intervention cardiology team will inject local anesthesia near the access site ( either the wrist or groin region ) so the patient will not feel any pain, and a small catheter is inserted through the skin and into the artery at the selected site. The intervention cardiology team will monitor the progress of the catheter into the heart through dynamic X-rays transmitted to a monitor screen. A patient does not feel the catheter going through the heart as there are not many nerves in the blood vessels of the heart.  Once the catheter head reaches the desired place in the heart an X-ray-sensitive dye ( a contrast media ) is injected through it. Further dynamic X-rays are captured as contrast media follows through the heart blood vessels. The coronary angiogram may last for up to 40 minutes. 

 

Cost of coronary angiogram or angiography in India.
Cost of coronary Angiogram                         Approx. 225 - 250 USD

Percutaneous Transluminal Coronary Angioplasty ( PTCA/PTCI ) or Heart angioplasty :

Coronary angioplasty ( PTCA ) or heart angioplasty is a minimally invasive cardiac procedure performed by an expert interventional cardiologist for the treatment of coronary artery disease. Percutaneous transluminal coronary angioplasty or heart angioplasty is performed in the cardiac catheterization laboratory ( cardiac cath. lab. ) to place or deploy a permanent wire meshed tube ( Cardiac coronary stent ) to open the narrowed or blocked coronary arteries in coronary artery disease ( CAD ) patients. The procedure is usually done under local anesthesia but the interventional cardiologist may opt to do the procedure under general anesthesia as well.

A PTCA (percutaneous transluminal coronary angioplasty ) or heart angioplasty can be performed simultaneously with the angiogram or angiography or later. More than one stent may also be placed in the narrowed or blocked coronary arteries, depending on the number of blocked arteries.

Types of coronary stents for PTCA/PTCI or heart angioplasty:

Our expert interventional cardiologists discuss various types of coronary stents before PTCA or heart angioplasty with coronary artery disease patients. The following types of coronary stents are used by the best interventional cardiologists in India for PTCA or heart angioplasty:

Bare metal stent for coronary angioplasty:

Bare metal stents are the commonly used coronary stents. Bare metal stents are made of stainless steel, cobalt chromium, or platinum chromium. These stents are devoid of any special coating. As the coronary artery heals after the angioplasty tissues grow around the bare metal stent and hold it in place to keep the lumen of the coronary artery open. 

Advantages of bare metal stent: 

These stents do not require long-term blood thinner or anticoagulation medications.

Disadvantages of bare metal stent:

The bare metal coronary stents are prone to scar tissue formation and overgrowth of scar tissues may cause reblocking of the artery.

Drug-eluting stent (DES) for coronary angioplasty:

Drug-eluting stents are also made of metal alloys like stainless steel, cobalt chromium, platinum chromium, or nickel titanium. Drug-eluting stent is coated with medications and polymer to control the release of the drugs.

Benefits of drug-eluting stents (DES):

The medications on drug-eluting stents do not allow the formation of scar tissue thereby reducing the chances of restenosis.

Disadvantage of drug-eluting stent (DES):

The polymer coating on the DES increases the risk of formation of the blood clots.

Bioresorbable Vascular Scaffold (BVS):

The BVS coronary stents are drug-eluting stents but on a self-dissolvable scaffold platform. 

Benefits of bioresorbable vascular scaffold (BVS) stents:

These stents also prevent restenosis of the coronary arteries because of the drugs. The BFS stent also offers the advantage of spontaneous back-and-forth movements inside the coronary artery.

Disadvantages of BVS coronary stents:

The healing process post the PTCA or heart stenting is prolonged.

Duel therapy stents (DTS):

Duel therapy stents are the best coronary artery stents, as they address all the shortcomings of other coronary stents. They offer the benefit of drug-eluting stents which means reduced chances of restenosis of the coronary artery and at the same time the medication on these stents hastens the healing process post a successful PTCA or heart coronary artery stenting.

Benefits of duel therapy coronary stents (DTS):

In the DTS, there is a drug coating inside and outside the stents that reduces the chances of inflammation and blood clots. These coronary artery stents ( DTS ) actively promote the healing process and prevent re-narrowing of the arteries.

Heart stent or Percutaneous Transluminal coronary angioplasty (PTCA/PTCI) cost in India:

The cost of PTCA heart coronary artery stenting in India depends and several factors:

  • The severity of narrowing or blockages of coronary artery
  • The number of blockages or number of coronary arteries involved
  • The types of Coronary stents used
  • The approach or route of cardiac catheterization
  • expertise in interventional cardiology
  • The hospital where the procedure is performed

The generalized cost of Percutaneous Transliminal coronary angioplasty in India is as follows:

Cost of investigations before PTCA 300 -500 USD
Cost of PTCA or coronary artery stenting 2000 - 4500 USD

 

Precautions post successful PTCA/PTCI or heart coronary angioplasty:

After a successful PTCA and discharge from the hospital, your treating interventional cardiologists may advise you about post-PTCA or heart coronary stenting care and precautions and certain Dos and Do-nots:

  • You may have to take prescribed blood thinning or anticoagulation medications to prevent blood clot
  • You will be advised to not take up any strenuous work or exercise in the first 24-48 hours after the procedure
  • You will also be advised of personalized cardiac rehabilitation
  • If you feel any chest pain or difficulty in breathing, dizziness or fainting, pain, bleeding, or swelling at the catheter site, any signs of infection at the catheter side, if you feel a change in temperature or color of the arm or leg used for cardiac catheterization, immediately report it to your interventional cardiologist.

Best doctors for PTCA/PTCI or coronary angioplasty in India:

PTCA ( coronary angioplasty ) or heart coronary stent procedure is performed by trained and expert interventional cardiologists. Top doctors for PTCA, coronary angioplasty ( heart stent procedure ) and interventional cardiology are:

 

  1. Dr. T.S. Kler, BLK max super specialty hospital, New Delhi, India.
  2. Dr. K. K. Saxena, Indraprastha Apollo Hospital, New Delhi, India.
  3. Dr. Ashok Seth, Fortis Escorts Heart Institute, New Delhi, India.
  4. Dr. Rajneesh Kapoor, Medanta - The Medicity Hospital, Gurugram, India.
  5. Dr. Manjinder Sandhu, Fortis Memorial Research Institute, Gurugram, India.

Top Hospitals for PTCA/PTCI (coronary angioplasty) in India:

The top JCI and NABH-accredited heart ( cardiology) treatment hospitals in India are:

  1. Fortis Escorts Heart Institute, New Delhi, India.
  2. Fortis Memorial Research Institute, Gurugram, India.
  3. Medanta - The Medicity, Gurugram, India.
  4. BLK Max Super Specialty Hospital, New Delhi, India.
  5. Indraprastha Apollo Hospital, New Delhi, India.

Frequently asked questions about PTCA/PTCI or coronary angioplasty:

Once you have been diagnosed with coronary artery disease and your attending doctor recommends a Percutaneous transluminal coronary angioplasty or heart coronary stenting, you may have certain doubts and questions. Your treating doctor will clarify any doubts and answer your questions. The frequently asked questions about PTCA are :

Is PTCA or heart coronary stenting an open heart surgery?

No. A PTCA or heart coronary stent procedure is not an open heart surgery rather it is a minimally invasive procedure to open the blocked or narrowed coronary artery by cardiac catheterization and placing the coronary stents to open the narrowed or blocked coronary artery.

What is better the PTCA ( Heart stent procedure) or bypass heart surgery ( CABG )?

Your treating heart ( Cardiology ) doctor will carefully examine your angiogram report, your age, your overall health, and the presence of any other disease like a kidney or lung disease before determining the best-suited treatment plan for treating your coronary artery disease.

For how long will I stay in the hospital and India for a PTCA or heart stent procedure?

A patient with coronary artery disease usually stays in the hospital post successful PTCA for 2 to 3 days. Hospital stay will also depend on recovery and the approach (route) for performing the PTCA procedure.

India's stay will be for 2 to 3 weeks for follow-up, complete recovery, and cardiac rehabilitation.

What Kind of coronary stent will be used for my PTCA or heart stent procedure?

Your treating interventional cardiologists will discuss various types of coronary stents and their pros and cons. After considering your age, overall health, and associated co-morbid factors will suggest the best-suited type of coronary stent for your PTCA procedure.

How CMCS Health will help me in my PTCA or heart stent procedure in India?

At CMCS Health, we endeavor to provide the best services to global medical travelers seeking PTCA or heart stent procedures.

  • We will get your medical opinion about the treatment course and cost from the best interventional cardiologists in India.
  • We empower you to select the best intervention cardiologist and top heart hospitals in India for your PTCA or heart stent procedure. 
  • We will help you in getting a medical visa for coming to India.
  • We will provide you performance invoice from your treating hospital and doctor about medical treatment costs.
  • We will assign a dedicated patient welfare executive, well versed in your language and English to take care of every aspect of your medical treatment and India stay.
  • We will help you in arranging a stay place in India during your medical treatment as per your need and budget.
  • We will coordinate your medical treatments most competently.
  • We will follow up on your progress once you reach back to your country after a successful PTCA and connect you with your treating interventional cardiologist via a video conference call to resolve any health issue.
  • If you have any other questions or doubts about coronary angioplasty or heart stent procedure, we can help you clear your doubts through a video conference call with leading interventional cardiologists in India.

We care for you and that is why we are your Global healthcare Guardians.