Лучшие больницы для «Coronary Artery Disease Treatment» в Мумбаи, Индия

Coronary artery disease is a chronic atherosclerotic condition characterised by the progressive accumulation of lipid-rich plaques within the intima of the epicardial coronary arteries, leading to luminal narrowing, reduced myocardial oxygen delivery, and — when plaques rupture — acute thrombotic occlusion resulting in ST-elevation or non-ST-elevation myocardial infarction. The haemodynamic consequences of significant stenosis (≥70% luminal reduction, or fractional flow reserve ≤0.80) include demand-supply mismatch during exertion (stable angina), resting ischaemia in more advanced disease, ventricular remodelling, systolic dysfunction, and ultimately heart failure if left untreated. Risk amplifiers such as Type 2 diabetes, dyslipidaemia, hypertension, chronic kidney disease, and smoking accelerate plaque burden and confer a substantially higher MACE (major adverse cardiovascular events) risk.

• ELIGIBLE PATIENTS (PCI / CABG):
• Stable CAD with significant single-, double-, or triple-vessel disease (FFR ≤0.80 or angiographic stenosis ≥70%) refractory to optimal medical therapy
• Acute coronary syndromes (STEMI, NSTEMI, unstable angina) requiring urgent or early invasive strategy
• Left main coronary artery disease (LMCA stenosis ≥50%) — Heart Team decision between PCI and CABG based on SYNTAX Score
• SYNTAX Score ≤22: PCI is preferred for multivessel disease
• +23 more

Pharmacological (optimised Medical Therapy — OMT):

All CAD patients receive evidence-based pharmacotherapy regardless of revascularisation strategy. Core agents include: high-intensity statins targeting LDL-C <55 mg/dL (ESC 2023 goal for very high-risk patients); PCSK9 inhibitors (evolocumab, alirocumab) for statin-intolerant or refractory hyperlipidaemia; dual antiplatelet therapy (DAPT) with aspirin 75–100 mg + ticagrelor 90 mg BD or prasugrel 10 mg OD post-ACS/PCI; beta-blockers (bisoprolol, metoprolol succinate); ACE inhibitors or sacubitril/valsartan (ARNi) for EF <40%; SGLT-2 inhibitors (empagliflozin, dapagliflozin) for cardioprotection and HF risk reduction; ranolazine or ivabradine for persistent angina on maximal therapy; colchicine 0.5 mg OD for residual inflammatory risk (LoDoCo2 evidence).

Percutaneous Coronary Intervention (PCI):

• Standard PCI: Radial-access preferred (reduced MACE and bleeding vs. femoral; MATRIX trial data); 6F or 7F guiding catheter; coronary angiography and real-time stenting under fluoroscopic guidance.
• Drug-Eluting Stents (DES): Third-generation ultrathin-strut biodegradable-polymer DES (e.g., Orsiro, XIENCE Sierra, Resolute Onyx) are the current standard, with restenosis rates <5% at 1 year.
• Intravascular Imaging-Guided PCI: Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are used routinely at partner centres to optimise stent sizing, apposition, and landing zones, reducing stent failure rates by 30–40% (ILUMIEN IV, OCTOBER trials).
• Physiology-Guided PCI: FFR (fractional flow reserve) and instantaneous wave-free ratio (iFR) used to defer stenting of non-flow-limiting lesions, reducing unnecessary procedures.
• Complex PCI Techniques: Rotational atherectomy (Rotablator) for heavily calcified lesions; orbital atherectomy; intravascular lithotripsy (IVL / Shockwave) for calcified nodules; chronic total occlusion (CTO) PCI using antegrade dissection/re-entry (ADR) and retrograde techniques — success rates >85% at high-volume centres.
• Haemodynamic Support: Impella CP/5.5 or IABP utilised for high-risk PCI (unprotected LMCA, severely reduced EF).

PHASE 1 — PRE-TRAVEL CONSULTATION (Weeks 1–2 before departure):

• GAF Healthcare coordinates a teleconsultation with the assigned interventional cardiologist or cardiac surgeon at the chosen partner centre.
• All diagnostic records (angiogram images/DICOM files, ECHO report, stress test, blood work) are reviewed remotely.
• A preliminary treatment plan — PCI vs. CABG vs. OMT — is confirmed by the multidisciplinary Heart Team.
• Patient receives a personalised cost estimate, visa assistance, pre-travel medication guidance (antiplatelet continuation/bridging instructions), and travel insurance advisory.
• GAF secures the hospital admission slot and arranges airport reception.

PHASE 2 — ARRIVAL AND PRE-PROCEDURE ASSESSMENT (Days 1–2):