Doctors Achieve Breakthrough in High-Risk Angioplasty for 60-Year-Old

A 60-year-old man from Bihar successfully underwent a high-risk angioplasty at Kokilaben Dhirubhai Ambani Hospital in Navi Mumbai, thanks to advanced mechanical support during the procedure. Diagnosed with severe multi-vessel coronary artery disease and an ejection fraction of only 20 percent, the patient faced significant health challenges after suffering a major heart attack.

The complexity of his condition was highlighted by critical blockages in two major coronary arteries and a complete blockage in a third artery, typically necessitating bypass surgery. However, due to the patient’s fragile state and findings from a cardiac MRI indicating severely compromised heart function, doctors ruled out the option of bypass surgery, categorizing it as extremely high risk.

Dr. Amit Singh, a Consultant Cardiologist at the hospital, evaluated the patient and determined that a carefully planned percutaneous coronary intervention (PCI) supported by an Intra-Aortic Balloon Pump (IABP) was the best course of action. “The patient had come to us with great hope after his condition was deemed too high-risk for a bypass. After detailed assessment and risk planning, we decided to go in for a complex PCI supported by mechanical circulatory support using an IABP,” Dr. Singh explained.

Understanding the Role of IABP

The IABP plays a crucial role in improving blood flow to the coronary arteries while alleviating the workload on the heart. Dr. Singh elaborated, “The IABP inflates during diastole, allowing the heart to fill with blood, and deflates just before systole to assist with blood ejection. This is critical during high-risk interventions, especially when blood pressure becomes unstable.”

Prior to the procedure, the patient was admitted for a day of haemodynamic optimization. This included stabilizing blood pressure and managing breathlessness due to heart failure-related fluid overload. During the PCI, the IABP was inserted through an arterial route, providing essential circulatory support. Doctors also implemented an ultra-low contrast strategy to minimize the risk of contrast-induced kidney injury, which can be particularly dangerous for patients with severely reduced heart function.

Despite encountering episodes of critical hypotension—a common complication in such cases—the mechanical support maintained circulation. This allowed the medical team to successfully revascularize the blocked arteries and place stents as necessary.

Successful Recovery and Discharge

“High-risk angioplasty in patients with such severely reduced heart function is never a routine decision. It requires meticulous planning, the right mechanical support, and a team that can respond instantly when pressures fall during the most critical steps,” Dr. Singh stated. The combination of IABP support, careful optimization, and low contrast usage enabled the team to restore blood flow across multiple severely diseased vessels while safeguarding other organs, particularly the kidneys, thus helping the patient avoid open-heart surgery.

Following the procedure, the patient was closely monitored in the intensive care unit, where IABP support continued for two days until haemodynamic stability was achieved. Remarkably, within 48 hours, he demonstrated significant clinical improvement, with stabilized blood pressure and preserved kidney function. He transitioned to a general ward and was discharged within four days in stable condition.

This case underscores the importance of advanced medical technologies and collaborative care in managing high-risk cardiac patients, paving the way for future interventions in similar cases.