Cardiologists break new ground by unblocking heart vessels using a diamond drill

Cardiologists at the Aga Khan University Hospital’s Heart and Cancer Centre facility recently broke new ground by using a diamond drill to unblock a major heart artery which was too hard to open with a balloon treatment alone.

An elderly patient from Uganda became the first patient to undergo this procedure in the region when it was performed and remains in a good state of health after he received this treatment.

According to Dr Mohamed Jeilan, Cardiologist at Aga Khan University Hospital, in heart attack patients with blocked coronary arteries, balloon expansion (or angioplasty) at the site of blockage has been the mainstay of treatment for more than two decades.

The balloon is guided using a special X-ray facility to the blocked vessel through a tiny catheter introduced via a very small puncture in the groin or the wrist. When the catheter is in place, a small amount of dye will be injected into it. X-rays will be taken as the dye travels through the coronary arteries.

After the balloon is removed, the doctor will usually place a stent (a metallic tube) to ensure that the artery has been kept open after the balloon has been removed.

DRILLING INTO THE HEART

In many patients, the vessel wall is too calcified (hardened) and the blockages are very long. In these patients, balloon inflations are unable to relieve the obstruction.

Doctors at the Aga Khan University Hospital delivered a miniature ‘rotablator’ drill (less than 1.5mm wide) which was small enough to fit into the very small heart vessels to bore open the artery.

The drill is coated with very tiny pieces of diamond crystal and is used in a catheter based procedure called rotational atherectomy. A specially designed diamond burr is used to grind away the blockage, rotating at more than 150 000 times per second.”

With coronary artery disease continuing to affect more Kenyans and the tide being on an upward surge, the Hospital continues to foster new technologies and therapies that have proved successful in other parts of the world.

The Heart and Cancer Centre has pioneered several procedures and this complex intervention comes in a long line of similar pioneering procedures opening up treatment options among patients suffering from heart diseases.

The Hospital’s Heart and Cancer Centre, the only one of its kind in East and Central sub-Saharan Africa, serves as the regional referral heart and cancer centre.

In addition to providing high quality tertiary cardiac and cancer care, the centre is a platform for scientific research and postgraduate sub speciality fellowship training.

This unique and technically advanced method is safe and effective and can be performed with little risk in the right hands. It has already been used in more than 50,000 cases worldwide and will now also benefit the population here and help define Nairobi as the capital of cardiovascular care in the region.

ABSORBABLE STENTS

A second introduction in the care of coronary artery disease includes placement of ‘absorbable stents’. The standard of care has been to use stents which are made out of precious metals such as platinum. The newest technology in this field involves the use of dissolvable stents which stay in place for several months before getting absorbed after the vessel has healed.

A middle aged woman received the first absorbable stent in the region last year and she remains well one year down the line. The stent technology was introduced first at the Aga Khan University Hospital’s Heart facility but it is anticipated that these stents will start to become available at other major centres in the region in the near future.

“Absorb is a first-of-its-kind device that functions like a metallic stent by opening a blocked artery in the heart and restoring blood flow. However, unlike a metallic stent, which cages the vessel, absorbable stent is more flexible and dissolves over time. 

This leaves behind a treated vessel free of a permanent implant with the potential to flex, pulse and dilate in response to various demands on the heart, based on people’s lifestyle and activities including exercise,” says Dr Jeilan.

Other coronary procedures which Aga Khan University Hospital has been in the forefront include Intravascular Ultrasound (IVUS).

Dr Jeilan explains that after performing a coronary angiogram, using a key-hole technique, doctors introduce a tiny ultrasound probe into the inside of our patient’s coronary artery and watch the moving images to assess the lining of the artery from the inside.

“The procedure allows us to decide whether the inner lining of the artery had been damaged significantly and whether a stent should be placed in the artery to improve the healing of the artery. This special catheter enables us to visualise the inside of the heart artery and take pictures which doctors can use to analyse the type and mechanism of narrowing in the artery,” she says.