Over its relatively short history, the field of interventional cardiology has grown tremendously. More than a million catheterizations are performed each year in the United States, offering safe and effective treatment for patients with coronary artery disease (CAD). And with each year there seems to new innovations that can treat a greater variety of conditions and increasingly complex cases. For symptomatic and obstructive coronary artery disease, percutaneous coronary intervention (PCI) with stenting has remained the preferred treatment. At Ascent Cardiology, we continue our relentless drive for procedural excellence, pursuing and applying the latest technical and technological advances in the field of PCI.
The hallmarks of our success lie not only with the employment of cutting-edge technology and techniques but also by employing a team approach, consistently applying protocols and techniques that, when employed by skilled interventionalists, result in excellent quality and outcomes. By using a system of established standard protocols and evidence-based treatment algorithms, rigorous attention to detail, and a strong sense of teamwork we achieve some of the best interventional outcomes in the region.
By taking the time to treat each patient as an individual, we have created an environment where patients not only feel compelled to ask questions and participate in their care but inevitably find themselves enthusiastic advocates of the Cardiac Catheterization Laboratory.
Interventional Cardiology is a specialized branch of cardiology requiring 1-2 years of specialized training after completion of a fellowship in General Cardiology. Only after successful completion of this extra training can a cardiologist perform these “interventions.” Interventional cardiology is a non-surgical option which uses a catheter, a tiny, 1-3 mm flexible tube, to repair damaged or weakened vessels, narrowed arteries or other structures of the heart. Using treatments like stent implantation, angioplasty, and valve repair or replacement, Interventional cardiologists also help patients avoid open heart surgery.
Catheterizations have classically been performed by gaining access to the arterial system from the groin (femoral access). However, this approach is not only associated with increased discomfort and recovery times but more importantly, carries a significantly increased risk of complications including significant bleeding. Hematomas and pseudoaneurysms at the site of femoral arterial access are frequent and often painful complications of heart catheterization. Retroperitoneal hemorrhage is another potentially life-threatening complication of femoral arterial catheterization. Certain patient populations, such as elderly and obese patients, are at an increased risk of bleeding complications from femoral arterial catheterization. Another point of access, the radial artery, provides a safer, more convenient option for performing catheterizations and interventions. Because the radial artery is small and superficial, it is easily compressible and therefore bleeding complications are extremely rare. Improved patient comfort is also a significant advantage to transradial cardiac catheterization. From the standpoint of patient comfort, femoral arterial catheterization requires patients to lie flat on their backs for up to 6 hours after completion of the procedure to prevent reopening of the puncture site and further bleeding. This can be especially uncomfortable in patients with orthopedic issues including patients with chronic back or other orthopedic issues. Transradial catheterization eliminates the need for postprocedural flat time, and most patients are able to begin walking immediately following the procedure. Patient preference is clearly in favor of transradial catheterization.
According to the latest compiled data from the American College of Cardiology, only 25% of cardiologists in the US currently perform transradial heart catheterizations and interventions. Highly trained in radial catheterizations and interventions, Dr. Diwadkar is one of the 25% of cardiologists in the country providing expertise in radial artery catheterization.
In the last few years, due to overutilization of coronary stenting by many interventional cardiologists, there has been a vigorous focus on the appropriateness of stenting. Cases that are inappropriate based on published guidelines are not only risky to the patient, since the intervention is not indicated, but also risk being denied reimbursement by federal agencies or insurance companies. At Ascent Cardiology, we utilize evidence-based protocols for proper evaluation of CAD before scheduling catheterization and possible intervention in conjunction with rigorous application of the appropriate use criteria (AUC) of the American College of Cardiology; this has yielded low rates of inappropriate PCI. Furthermore, the employment of fractional flow reserve (FFR), a technology used in the catheterization lab to precisely identify specific coronary blockages causing ischemia or reduced blood flow to the myocardium, in our clinical practice further guides our decision making for preventing inappropriate PCI.