Complex and High-Risk Angioplasty (CHIP) Procedures - An Advanced Cardiac Intervention for Enhancing Safety and Recovery

Patients with complex heart disease are at high risk for standard procedures or open-heart surgery. These patients often have severely blocked or calcified arteries, including chronic total occlusions (CTOs), multiple blockages or significant co-morbidities such as kidney issues, heart failure or uncontrolled diabetes. Dr. Refai Showkathali, Senior Consultant Interventional Cardiologist, Apollo Hospitals, Greams Road, Chennai enumerates on the CHIP (Complex High-risk Indicated Percutaneous Coronary Intervention) procedure, an advanced, pinhole minimally invasive angioplasty procedure for patients with complex heart disease. CHIP PCI uses specialized tools and techniques to restore blood flow, offering new hope for patients who might otherwise not be candidates for treatment. CHIP heart procedures restore blood flow to the heart muscle that can improve symptoms like angina and heart failure, enhance cardiovascular function and improve the patient’s quality of life.

CHIP Patients

Patients selected for CHIP procedures include,

• Those with anatomical challenges such as severely blocked arteries due to heavy calcium burden, including chronic total occlusions and multiple, calcified or long lesions, location of the blockage in the main artery or at the place of division.

• Clinical factors such as advanced age, kidney failure, severe heart failure, previous stroke, obesity, lung-related issues or other coexisting medical conditions.

• Open Surgical ineligibility or high open surgical risk

   

Techniques and Tools Used in CHIP Procedures

CHIP PCI procedures should ideally be performed by trained and expert operators in high volume centres. There are various specialised tools to successfully perform CHIP procedures in a safe manner. These include Drilling techniques like Rotational atherectomy and Orbital atherectomy, Laser angioplasty, Intravascular Lithotripsy (IVL), Specialised cutting and scoring balloons to crack the calcium inside the coronary arteries so that ballooning and stent implantation becomes easy after these techniques.

In some situations where the patient has significant kidney related issues, angioplasty should be performed with minimal usage of contrast (dye) as this may further aggravate the kidney issue leading to dialysis. Therefore, techniques like Ultra-low contrast angioplasty are performed with use of special imaging catheters inside the blood vessel called Intravascular Ultrasound (IVUS), which acts as a camera and gives a 3D view of the blood vessel. This can help in deciding the exact size of the stent to be used without the need for dye injection. In patients with heart failure (weak pumping of the heart), complex procedures like drilling techniques carry a higher risk. In these situations, special devices like Intra-aortic Balloon pump (IABP), ECMO or devices like Impella are used to reduce the risk. These are called mechanical circulatory support (MCS) devices, which are inserted into the patient during these complex angioplasty procedures to protect the heart. Recently, Dr. Refai Showkathali performed a CHIP procedure on a 58-year-old patient who visited Apollo Hospitals , Greams Road with chest pain. His heart pumping was found to be extremely weak and he had a kidney problem. He had heavily calcified blockages in the heart blood vessel. “ The only way to treat him was to employ the drilling technique with Impella support. We performed this procedure successfully at Apollo Main Hospital, Chennai and implanted 3 stents to improve the blood flow. He was discharged within 48 hours and the patient is doing extremely well with full recovery of his heart muscle,” says Dr.Refai Showkathali.

Featuring insights from Dr. Refai Showkathali, Cardiology, Apollo Hospitals, Greams Lane, Chennai

📞 For appointments, call Apollo Hospitals Chennai at 044 4040 1066