Cardiovascular Disease (CVD), the name responsible for 31% of all deaths globally, amounting to an approximate 17.9 million deaths annually is, according to WHO, the number one killer and the leading cause of death. 80% of these deaths are attributed to heart attacks and strokes, owing largely to Coronary Artery Disease (CAD).

CAD is a chronic disease caused by the narrowing or blockage of the coronary arteries – blood vessels supplying blood to the heart. As we age, fats in the blood vessels accumulate, causing slight damage to the blood vessel wall. Over time, other blood components such as calcium, protein and inflammatory cells et cetera stick to the blood vessel wall, combining with the accumulated fat to form fatty deposits, also known as plaque.

As plaque within the blood vessels increases, this causes the interior of the blood vessels to narrow and eventually harden, a process also known as atherosclerosis. This results in decreased blood flow to the heart muscle, thereby reducing the amount of oxygen delivered to the heart and all this eventually leads to chest pain or a heart attack. Patients with CAD typically experience symptoms such as chest pain (i.e. discomfort, pressure, numbness), shortness of breath, heart palpitations, dizziness, nausea, extreme weakness and sweating.

In most cases, lifestyle changes such as regular exercise, a healthier diet and quitting smoking are recommended. In more severe cases, drugs such as cholesterol-modifying medications, aspirin to reduce blood clot risks, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) for control of heart rate and blood pressure, ranolazine for chest pain may also be administered to treat CAD.

Often, more aggressive treatment or interventions to restore or improve blood flow is required. These interventions are usually Percutaneous Coronary Intervention (PCI) or Coronary Bypass Surgery (CABG).

Although PCI procedures are generally safe, some complications such as tearing of the coronary arteries, bleeding, blood clots leading to stroke or heart attack may occur. About 30% of PCI patients suffer from moderate to severe calcification in their vessels. They are generally older and have more complex lesions. This increases the risks of PCI procedural failure and stroke when the plaque dislodges from the heart and travels to the brain.

To minimise these complications, as well as improve overall clinical outcomes, imaging is often used. The current gold standard in imaging is coronary angiography. However, angiography is limited to at best, 2D images of the vessel and does not reflect the 3D structure of the vessel. It is thus unable to provide information on plaque composition, vessel diameter and how post-stent deployment may be like. Hence, intravascular imaging modalities such as Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) have emerged to address the limitations of angiography. 

With advancements in Medtech, new imaging modalities at diagnosis helps to provide doctors with a deeper understanding of the patient’s plaque composition and vessel interior. These include:

• IVUS: This technique has shown to be more sensitive in identifying mild calcium within the vessel than standard angiography. Here’s how it works. A catheter is threaded through an artery to the heart and a transducer at the end of the catheter produces ultrasound waves that reflect off the arterial walls and receives the resulting echoes. The echoes are then converted to images.
• OCT: This technique uses near-infrared light to obtain much higher resolution images of the interior of the coronary arteries compared with IVUS. An OCT catheter containing an optical fibre emitting infrared light is inserted into the vessel to determine the type of plaque and plaque length, possible position of the stent and how it can hold the vessel open during the procedure.
• FFR: Instead of a catheter, this technique passes a special guide wire through a standard but smaller catheter to measure the blood flow and pressure, following the infusion of a hyperaemic agent. An FFR value is computed which indicates whether there is a need for PCI. New FFR measurement (i.e. iFR) which do not require hyperaemic agents has also been approved by FDA

From there on, doctors can determine if supplementary treatment methods are required. Often, atherectomy devices are used to remove the plaque, softening these rigid vessels to allow full balloon dilation during angioplasty procedures with lesser risks of stent fracture during stenting.

With these advancements, patients and healthcare practitioners can make better decisions, leading to lesser risks of complications and ultimately, better recovery and clinical outcomes.

For this, Genesis MedTech has been actively pursuing new advancements through its open innovation platform that invites leading innovators to collaborate and bring cost-effective technologies to emerging markets. In March 2021, Genesis partnered with Shockwave Medical, Inc, a pioneer in the development of Intravascular Lithotripsy (IVL) to treat severely calcified cardiovascular disease, to introduce IVL to the Chinese market. This marks an important milestone in helping many patients in China who suffer from calcified arterial disease. More developments are in the pipeline to continue to develop technologies that will serve unmet needs in this space.