'Lifesaver' for patients with coronary artery stenosis and kidney failure

Currently, thanks to the application of Ultra-low Contrast technique including a "trio" of 360-degree rotating coronary angiography robots (Cardiac Swing) combined with the "compass" Dynamic Coronary Roadmap (DCR) for orientation and the "magic eye" (IVUS) for stent placement guidance, in some cases, doctors at Tam Anh General Hospital can use only 1/5 of the amount of contrast agent compared to conventional techniques, preserving kidney function, reducing restenosis, and improving the quality of life for patients.

By applying Ultra-low Contrast technique including Cardiac Swing, Dynamic Coronary Roadmap (DCR) compass and Intravascular Ultrasound (IVUS) guidance, doctors can use only 1/5 of the amount of contrast agent compared to conventional technique.

MINIMAL CONTRAST STENT PLACEMENT, PRESERVING RENAL FUNCTION

After 3 days of coronary stent placement, Ms. Nguyen Thi Minh (67 years old, living in Tien Giang), a patient with stage 4 kidney failure, is feeling better, no longer has chest pain or difficulty breathing. For the first time in many years, she can sleep deeply, eat well and walk comfortably in the hallway without chest heaviness or shortness of breath. Cardiovascular function has improved significantly compared to before the intervention. The heart pumps blood better, increasing blood flow to the kidneys. Kidney function shows no signs of worsening but is gradually improving.

This is one of hundreds of elderly patients with severe, complicated coronary artery stenosis and many underlying diseases such as kidney failure, heart failure, diabetes, and inoperable conditions... who have been successfully treated at Tam Anh General Hospital.

Last month, Ms. Minh was hospitalized twice for signs of myocardial infarction. She has high blood pressure, diabetes, and stage 4 kidney failure. If she had a coronary angiogram, she would need to inject about 20-30 ml of contrast medium into her body, which would cause kidney failure to progress and require dialysis. Her family chose medical treatment to relieve the symptoms. Her chest pain has not been completely resolved.

"To assess the condition of the coronary arteries, doctors often have to take 6-8 angles, equivalent to 6-8 injections of contrast agent, each injection of 2-4 ml, so the entire process of taking the contrast agent into the patient's body can be up to 20-30 ml. For patients with kidney failure, receiving a large amount of contrast agent will cause the disease to progress, and in severe cases, dialysis is required," said Master - Doctor CKII Vo Anh Minh, Head of the Coronary Intervention Unit, Vascular Intervention Center (Tam Anh General Hospital, Ho Chi Minh City).

Dr. Huynh Ngoc Long, Director of the Vascular Intervention Center, next to the Philips Azurion Robotic Ceiling FlexArm digital subtraction angiography (DSA) system hanging from the ceiling with a 360-degree rotating robotic arm.

Tam Anh General Hospital is the first unit in Vietnam to be equipped with the Philips Azurion Robotic Ceiling FlexArm digital subtraction angiography (DSA) system, which is suspended from the ceiling and integrates three modern software in cardiovascular intervention such as minimal contrast coronary angiography (Cardiac Swing), "magic eye" intravascular ultrasound (IVUS) and "compass" orientation (Dynamic Coronary Roadmap) to help optimize the process of coronary angiography and stent placement with the lowest amount of contrast agent.

With a 360-degree rotating robotic arm around the patient combined with dual-axis imaging technology (continuously capturing images as the robotic arm rotates around the patient) of Cardiac Swing software, with just 2 shots with a total of 7 - 8 ml of drug, the system can fully and clearly record images of coronary artery lesions at all angles.

Thanks to the "magic eye" of IVUS intravascular ultrasound combined with the "compass" of orientation and experience in intervening in complex cases, the doctor accurately determines the diameter of the vascular lumen and the location where the stent needs to be placed instead of injecting contrast agent. From there, the balloon is dilated and the stent with the largest diameter is placed with the lowest amount of contrast agent, in the shortest time.

"If we apply conventional techniques to recanalize the two main blood vessels that feed the heart, which are 90-95% narrowed, and the remaining branch is 99% narrowed like this patient, we may need to inject up to 100 ml of contrast agent; but we only used 12 ml for both the imaging and intervention process," Dr. Anh Minh shared.

INTERVENTIONAL CARDIOVASCULARITY REACHES THE WORLD

Doctor CKII Huynh Ngoc Long, Director of the Vascular Intervention Center, Tam Anh General Hospital, Ho Chi Minh City, cited evidence that the Cardiac Swing technique is highly effective in the world. The research results were published in the US National Library of Medicine, after coronary angiography using the Cardiac Swing technique for 107 patients and the conventional technique for 104 patients, the amount of contrast agent needed in the Cardiac Swing technique was reduced by more than 36% compared to the conventional technique and 64% of patients only needed 2 scans to have a complete, satisfactory coronary artery image.

APPLYING HIGH TECHNOLOGY TO BRING THE BEST QUALITY OF LIFE TO PATIENTS

Tam Anh General Hospital has inherited and promoted the world's advanced cardiovascular intervention techniques. The hospital has successfully placed "giant" stents with diameters of up to more than

5 mm for many cases of coronary artery stenosis with complex underlying disease, with a very low rate of restenosis.

In the future, we will continue to update new technologies to bring patients the best health and quality of life.

MD, PhD Huynh Ngoc Long

According to information from Philips, the study also noted that the Dynamic Coronary Roadmap (DCR) "compass" helps reduce the amount of contrast agent used by 28.8% compared to intervention techniques without DCR, contributing to protecting patient health.

In addition to Cardiac Swing, Dynamic Coronary Roadmap, the IVUS "magic eye" is crystallized from millions of platinum crystals and electronic chips to display vivid 3D images of the lumen and the blood vessel wall. This optimizes the stent placement process, helping doctors choose the largest and longest diameter stent, expand the stent to the maximum, close to the blood vessel wall, reducing the risk of acute occlusion or restenosis after stent placement. Compared to the traditional stent placement technique, the new technique helps reduce the rate of acute occlusion (endothelial layer dissection, acute thrombosis within one month after stent placement) to 0.44% (compared to 1.7% of the conventional technique); restenosis to 1.6% in the first year (compared to 5.2%) and 4.2% in the next 3 years (compared to 10.7%).

"At Tam Anh General Hospital in Ho Chi Minh City, statistics show that after intervention, the rate of acute obstruction is 0%, and restenosis is 0.4%, equivalent to the world's results. This is a new step forward that doctors at Tam Anh General Hospital have strived to achieve, and also shows that interventional cardiology in Vietnam has reached world-class standards," Dr. Long affirmed.

Along with that, advanced techniques such as drilling and cutting calcified plaques with a diamond-coated drill (Rotablator), assessing vascular physiology (iFR/FFR), radial artery intervention (at the wrist)... have supported the stent placement process to achieve optimal efficiency. In particular, thanks to the application of artificial heart-lung machine (ECMO) technique right in the cardiac catheterization room, Tam Anh General Hospital has saved the lives of many patients with severe myocardial infarction complications leading to cardiogenic shock and cardiac arrest.

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