Nagpur: In a unique case, a 60-year-old patient undertook a procedure called Hybrid revascularization (opening of blocked Arteries) in Wockhardt Hospitals in Nagpur. This procedure was performed by a team led by Dr. Dinesh Padole, Consultant- Cardiology, and Dr. Sameet Pathak, Consultant- Cardiac Surgery.
Hybrid revascularization refers to complete or near-complete revascularization using a combination of angioplasty and CABG or vice versa (often during the same hospital stay).
The patient, hailing from Nagpur, had blocked arteries to both kidneys (critical bilateral renal artery stenosis) with blockages of all three vessels of the heart (critical triple vessel coronary artery disease) with accelerated hypertension, diabetes, and acute kidney injury.
“The Patients appropriate for this technique vary widely from low risk to high risk with multiple comorbidities, who intend to benefit the most after a heart-team discussion”, informed Dr. Dinesh Padole (Interventional Cardiologist and consultant in charge of the patient), who undertook this rare combination of Angioplasty and CABG on the same day.
The patient was at high risk for direct CABG in view of critical bilateral renal artery stenosis as the patient had High Blood pressure which was not getting controlled with a maximum number of anti-hypertensive medications and recurrent pulmonary edema.
After a Critical Assessment of the situation, the heart team (Cardiologist, cardiovascular surgeon, anesthetist, intensivist, patient’s relatives) decided to take up the patient for rare hybrid procedure-bilateral renal artery stenting followed by CABG on the same day, after explaining the critical and rare condition to patients relatives. Both the procedures (Bilateral renal angioplasty followed by CABG) were completed within six hours.
Dr. Dinesh Padole (Interventional Cardiologist) and consultant in charge informed that there is a high risk of stent thrombosis (blockages) in such patients which was reduced with the use of a novel blood-thinning medication called cangrelor during and after renal angioplasty and CABG. Dr. Sameet Pathak (CVTS Surgeon) performed a CABG of the patient and informed that patient had an uneventful postoperative period. The patient has been discharged and has come for his follow-up with no complaints. Happy patients, Happy doctors!
