Clinical Services
Cardiovascular disease is the leading cause of death for both men and women in industrialized countries. Most cardiovascular-related deaths are due to coronary artery atherosclerosis causing luminal stenosis or occlusion. In 1977, the only technique enabling coronary revascularization was bypass, which required major surgery.
Several noninvasive exams are used to identify coronary disease (coronary CT scan) or assess its functional impact (exercise electrocardiogram, cardiac stress test, myocardial scintigraphy, cardiac MRI). However, the coronary angiogram is the only exam allowing doctors to detect and assess coronary disease with certainty. Moreover, it enables educated therapeutic decisions, as each case is discussed by the medical team and the patient. In most cases, percutaneous coronary intervention (PCI) is performed directly.
A coronary angiogram is a radiological examination of the coronary arteries. A very small tube-like device is inserted into one of the large peripheral arteries until the tip is just within the opening of one of the coronary arteries that supply blood to the heart. A special liquid (radiocontrast agent, or dye) is then injected. This agent allows for X-ray visualization of the blood flow. At the American Hospital of Paris, most diagnostic coronary angiograms are performed transradially, allowing the patient to get up immediately and go home the same day.
While the coronary angiogram only shows luminal diameter, intracoronary ultrasound is the first clinical exam to offer visualization of arterial wall atherosclerosis. IVUS is particularly useful for evaluating coronary lesions and determining interventional techniques. The American Hospital of Paris is equipped with the latest-generation technologies that provide ultra-high-definition imaging, including tissue characterization (virtual histology) by radio-frequency spectral analysis for a more accurate identification of vulnerabilities and more precise evaluation of rupture risks.
Invasive measuring of intracoronary blood pressure and flow provides supplementary information to the anatomic characterization provided by the coronary angiogram and IVUS. We feel this physiological assessment is especially useful in considering therapeutic approaches, particularly in the case of intermediate stenosis.
Today, most coronary angiograms lead to percutaneous coronary intervention, also called angioplasty or coronary dilation. Coronary intervention is the most effective therapy for the treatment of coronary disease. Over one million PCIs are performed each year worldwide, including over 120,000 in France. PCI uses catheterization and is performed by an interventional cardiologist to restore blood flow in narrowed or occluded coronary arteries. For many years now it has been the most common form of myocardial revascularization. It employs a less invasive technique than bypass, and requires less time and fewer resources while usually allowing the patient to leave the hospital the very next day. Angioplasty can be performed as part of a scheduled coronary disease treatment or as an emergency procedure to treat heart attack.
An empty and collapsed balloon on a guidewire is passed through a large artery at the groin or wrist and inserted into the narrowed or obstructed locations. It is then inflated so as to push the plaque and the artery wall outward, thereby widening the artery and restoring blood flow. The devices are then removed.
In nearly all PCIs performed today, a metal implant called a stent is placed during or after coronary angioplasty. While the balloon used during PCI is removed, the stent permanently remains in the widened artery. Stents have nearly eliminated acute complications in coronary angioplasty (in particular acute coronary occlusion by dissection), post-operative myocardial infarction and emergency coronary bypasses. Furthermore, the use of stents has resulted in a 50% drop in relapse (restenosis) and repeat interventions during the 6 to 12 months following the angioplasty. More recently, Drug-Eluting-Stents (DES) have become the most widely used stents worldwide. These implants release small doses of medication in the weeks following their placement so as to prevent scar-tissue growth inside the stent and possible artery obstruction. Drug-Eluting-Stents have further reduced restenosis (re-obstruction) rates, to approximately 5%. These new stents require prolonged anti-platelet treatment, usually for at least one year following the procedure.
At the American Hospital of Paris, all percutaneous coronary intervention techniques are available, including Japanese guiding catheters specifically designed for Chronic Total Occlusion (CTO), thromboaspiration catheters (for myocardial infarction emergency treatment), cutting balloons, rotational atherectomy drills, and of course left ventricular assist devices with intra-aortic balloon pumps in cases of cardiogenic shock. These methods now enable us to treat more complex lesions (left common artery, complex bifurcations, chronic occlusions, diffuse lesions, etc.).
At the American Hospital of Paris, an anesthesiologist is always present to administer conscious sedation to prevent pain and anxiety during the treatment. The cardiologist also enjoys a more favorable setting and a higher level of concentration. Anesthesia monitoring through real-time spectral analysis of the electroencephalogram enables optimal conscious sedation.
These are performed by vascular interventional radiologists and vascular surgeons of the American Hospital of Paris.
Established over 25 years ago, the Interventional Cardiology Unit of the American Hospital of Paris provides patients suffering from cardiovascular diseases with the latest-generation invasive diagnostic and interventional techniques.
American Hospital of Paris - 63, Bd Victor Hugo
