The outpatient procedure is performed in high-risk patients or in those who have coronary lesions that affect long lesions, bifurcations or small vessels, among others.
Cardiovascular disease is the leading cause of death in the world ahead of cancer, according to data from the World Health Organization (WHO). Furthermore, it represents one of the issues of greatest concern among experts worldwide. However, currently there are different procedures to address heart complications, such as the drug-active balloon (PAB).
As explained by Dr. Jorge Palazuelos, head of the Hemodynamics and Interventional Cardiology Unit at La Luz University Hospital, “it is a small angioplasty balloon that we use to unclog the arteries of the heart. It is coated with an immunosuppressive drug that allows the arteries to be cleaned in a more controlled and safe way. In some cases, it prevents us from having to put in a coronary stent.”
Normally, the technique is performed in high-risk patients either because they have comorbidities, associated diseases that can predispose to complications, such as anticoagulation problems, bleeding, stroke, kidney failure, etc., or because "the angiographic findings that we see When doing the coronary angiography they tell us that there are lesions in very small vessels or very long lesions, of great extension, that affect bifurcations, branches, arteries that previously had a stent (mesh) and that it has become dirty again."
A fast and safe procedure
The drug-active balloon technique begins when the clinical cardiologist suspects that the patient has ischemic heart disease, “either because of the symptoms he or she presents, because of the stress tests or because of the other non-invasive tests that have been requested,” says Dr. Palazuelos. .
In this way, the professional refers the patient to the hemodynamics room so that the team of experts can perform a diagnostic coronary angiography, which allows them to confirm or not that suspicion: “If it is confirmed that there is dirt, this test allows, Also, treat,” adds the doctor. In that sense, he emphasizes that “we are talking about coronary, percutaneous intervention or angioplasty. As in coronary angiography, in angioplasty, normally, the first thing we do is puncture, with local anesthesia, the radial artery, we introduce a guide (very fine wire) that reaches the heart and, through it, we insert a catheter , a long hollow plastic tube. With the catheter and the wire that is in the artery, we introduce the drug-active balloon to unclog the arteries,” explains Palazuelos. That is, we are able to bring the drug that is going to be used to treat and take it only to the site we want with the help of a balloon.
If the patient meets the aforementioned criteria, that is, long lesion, small vessel, restenosis, bifurcation, etc., the specialists, after pretreating the lesion with a conventional balloon, introduce a second balloon, which is impregnated with the immunosuppressive drug, " and there we stop the procedure, the treatment, that is, it is not necessary to continue and put a stent or a mesh.”
Regarding recovery, Dr. Jorge Palazuelos assures that it is “very good and fast because, normally, the patient comes to the hospital one day and has the procedure done on an outpatient basis.” After the intervention, a compress is placed on the wrist for four or five hours and, when the team of professionals confirms that there is no longer bleeding from the puncture area, it is removed. The rest of the day, the person remains in the hospital walking and under observation and, after 24 hours, is discharged.
It should be noted, according to Dr. Palazuelos, that the first two or three days, the patient “must avoid making significant physical efforts with the arm and, then, for approximately 15 days, he must avoid intense efforts that occur when running or in the gym so that the area heals and looks good.”
The drug-eluting balloon is used in the Hemodynamics and Interventional Cardiology Unit of UICAR.