In the past, the only treatment available, in case of patients of heart attacks, was extensive surgery, which was not only very risky but also required a recovery time of several weeks. But now, the novel non-surgical method of “endoluminal stent graft” has made the treatment much simpler.
The endoluminal stent graft technique not only carries lower risk, it also makes for minimal blood loss, rapid recovery and allows the patient to start walking in two or three days.
This new technique has gained in popularity across the world and in various metro towns of the country. Through an incision in the groin done under local anaesthesia, a stent graft is taken to the blocked artery and placed, very much like a new tube within the ballooned or choked area.
However, the technique may still be in the phase of development in cities like Kanpur and Lucknow. Here in Kanpur, to perform cathlab demonstration to leading heart surgeons of the town and to give live demonstrations on coronary angioplasty without surgical invasion, Dr. Neeraj Bhalla of Delhi’s Metro Heart Institute talked to The Hi Time Express regarding the latest developments in the field of endovascular interventional therapy.
“As far as I know, there is only one hospital that has cathlab facilities in Kanpur, which is nothing compared to the population of the city. Delhi has about 30 cathlabs and growing. Even in Lucknow, despite the presence of SGPGI and other hospitals, only a small percentage of population can gain access to this kind of treatment,” said Dr. Bhalla, adding further that: “When the patient comes with heart attack, our first option is to take him to cathlab. There, a primary angioplasty is done at first and a stent is stalled wherever the blockage is. But in many places, in cities like Kanpur where these facilities are not readily available, the treatment revolves around giving clot dissolving drugs, known as thrombolytic therapy. But this is effective only in one-third of the patients. Based on the new trials done in Delhi and elsewhere, my topic during the presentation was to discuss how to improve the outcome of these patients, so that they survive longer and enjoy a better life. Training was imparted to cardiologists in Kanpur, about the latest techniques and so as to help them set up international cathlabs.”
The cathlab procedures are very complex and the cardiologists who treat the patients are the best in their field, in any hospital here or abroad. The need therefore, is to keep abreast of the latest technologies and techniques and to train accordingly. Dr. Bhalla spent several hours imparting the crucial knowledge to colleagues in Kanpur to ensure top-class parameters.
Referring to the latest techniques in stent implantation, Dr. Bhalla said: “Now drug eluting stents are in the second generation. These have either no polymer or have bio-degradable polymers which do away with the problems faced earlier, by the first generation stents. Third generation may see bio-degradable stents where the stents will completely dissolve in 4-6 weeks.
When asked what he was doing to bring the cost of stent under the paying capacity of middle-class patients, if not lower, Dr. Bhalla referred to a Customer Feedback Programme organized by Cordis, a leading manufacturer of stents, by saying: “I happen to be one of the larger users of Cordis stents in the city of Delhi. The questionnaire given to cardiologists during the Feedback Programme asked what should be Cordis’s priority and nearly all the cardiologists answered that the need of the hour was to produce stents of lower cost, so that it can be used on more patients.” The costing of stents is a very burning problem particularly so because the stents manufactured by Cordis, Guidant and others are outsourced and the locally manufactured stents are lower in quality. “Cost will only be reduced when quality stents are manufactured locally,” said the doctor.
Dr. Bhalla also talked of a myth as per which attack can occur only in the heart. In fact, attacks due to blockage can occur anywhere, including the neck, brain and the leg. “That is why we are known as endovascular specialists,” said he. “There was a patient in whom I planted a coronary stent in an artery that goes to the arm and another in the artery that goes to the head. We routinely do renal angioplasty which means implanting stents in the vessels that go to the arteries of kidney. At times, stents are implanted in the lower limbs as well,” added the doctor, giving example of a Pakistani lady, who was suggested amputation but he managed to retain her legs by implanting three stents.
Talking about the growing number of patients from Pakistan, Bangladesh, Nepal, Afghanistan and Gulf, Dr. Bhalla said that the Government of India is promoting the concept of Medical Tourism aggressively. Many agencies are ready and willing. India, of course, has a large body of medical talent available and at very nominal cost compared to the West. “Hopefully, medical tourism from the West too will become a reality soon,” added Dr. Bhalla.
Fast Facts
Middle-class should take care of their health from early on in life. Most of the blockages in the arteries take a long time to form, and when they are discovered the patients start taking preventive measures. It is better for those with a family history of blockages, to take precautions from a young age.
The cholesterol blockages in the arteries can affect any part of the body and not necessarily the heart. Kidney blockage leads to hypertension and kidney failure, while clogging in the brain leads to strokes. While the same symptoms in the legs leads to gangrene and acute pain. While these ailments need professional intervention, the middle-class bulk of society needs to regularly get its cholesterol levels checked, exercise without fail, eat a controlled diet and get their blood pressure checked regularly.
The endoluminal stent graft technique not only carries lower risk, it also makes for minimal blood loss, rapid recovery and allows the patient to start walking in two or three days.
This new technique has gained in popularity across the world and in various metro towns of the country. Through an incision in the groin done under local anaesthesia, a stent graft is taken to the blocked artery and placed, very much like a new tube within the ballooned or choked area.
However, the technique may still be in the phase of development in cities like Kanpur and Lucknow. Here in Kanpur, to perform cathlab demonstration to leading heart surgeons of the town and to give live demonstrations on coronary angioplasty without surgical invasion, Dr. Neeraj Bhalla of Delhi’s Metro Heart Institute talked to The Hi Time Express regarding the latest developments in the field of endovascular interventional therapy.
“As far as I know, there is only one hospital that has cathlab facilities in Kanpur, which is nothing compared to the population of the city. Delhi has about 30 cathlabs and growing. Even in Lucknow, despite the presence of SGPGI and other hospitals, only a small percentage of population can gain access to this kind of treatment,” said Dr. Bhalla, adding further that: “When the patient comes with heart attack, our first option is to take him to cathlab. There, a primary angioplasty is done at first and a stent is stalled wherever the blockage is. But in many places, in cities like Kanpur where these facilities are not readily available, the treatment revolves around giving clot dissolving drugs, known as thrombolytic therapy. But this is effective only in one-third of the patients. Based on the new trials done in Delhi and elsewhere, my topic during the presentation was to discuss how to improve the outcome of these patients, so that they survive longer and enjoy a better life. Training was imparted to cardiologists in Kanpur, about the latest techniques and so as to help them set up international cathlabs.”
The cathlab procedures are very complex and the cardiologists who treat the patients are the best in their field, in any hospital here or abroad. The need therefore, is to keep abreast of the latest technologies and techniques and to train accordingly. Dr. Bhalla spent several hours imparting the crucial knowledge to colleagues in Kanpur to ensure top-class parameters.
Referring to the latest techniques in stent implantation, Dr. Bhalla said: “Now drug eluting stents are in the second generation. These have either no polymer or have bio-degradable polymers which do away with the problems faced earlier, by the first generation stents. Third generation may see bio-degradable stents where the stents will completely dissolve in 4-6 weeks.
When asked what he was doing to bring the cost of stent under the paying capacity of middle-class patients, if not lower, Dr. Bhalla referred to a Customer Feedback Programme organized by Cordis, a leading manufacturer of stents, by saying: “I happen to be one of the larger users of Cordis stents in the city of Delhi. The questionnaire given to cardiologists during the Feedback Programme asked what should be Cordis’s priority and nearly all the cardiologists answered that the need of the hour was to produce stents of lower cost, so that it can be used on more patients.” The costing of stents is a very burning problem particularly so because the stents manufactured by Cordis, Guidant and others are outsourced and the locally manufactured stents are lower in quality. “Cost will only be reduced when quality stents are manufactured locally,” said the doctor.
Dr. Bhalla also talked of a myth as per which attack can occur only in the heart. In fact, attacks due to blockage can occur anywhere, including the neck, brain and the leg. “That is why we are known as endovascular specialists,” said he. “There was a patient in whom I planted a coronary stent in an artery that goes to the arm and another in the artery that goes to the head. We routinely do renal angioplasty which means implanting stents in the vessels that go to the arteries of kidney. At times, stents are implanted in the lower limbs as well,” added the doctor, giving example of a Pakistani lady, who was suggested amputation but he managed to retain her legs by implanting three stents.
Talking about the growing number of patients from Pakistan, Bangladesh, Nepal, Afghanistan and Gulf, Dr. Bhalla said that the Government of India is promoting the concept of Medical Tourism aggressively. Many agencies are ready and willing. India, of course, has a large body of medical talent available and at very nominal cost compared to the West. “Hopefully, medical tourism from the West too will become a reality soon,” added Dr. Bhalla.
Fast Facts
Middle-class should take care of their health from early on in life. Most of the blockages in the arteries take a long time to form, and when they are discovered the patients start taking preventive measures. It is better for those with a family history of blockages, to take precautions from a young age.
The cholesterol blockages in the arteries can affect any part of the body and not necessarily the heart. Kidney blockage leads to hypertension and kidney failure, while clogging in the brain leads to strokes. While the same symptoms in the legs leads to gangrene and acute pain. While these ailments need professional intervention, the middle-class bulk of society needs to regularly get its cholesterol levels checked, exercise without fail, eat a controlled diet and get their blood pressure checked regularly.
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