Chairman, Cardiac Sciences, Fortis Hospital, Noida
Part 4 of 8 in Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
Treating Aortic and Carotid Aneurysms With a Minimally Invasive Stent
December 1, 2024
An aneurysm is a section of artery that has ballooned outward and can rupture without warning. Dr. Ajay Kaul, Chairman of Cardiac Sciences at Fortis Hospital, Noida, described how the treatment for this condition has shifted just as dramatically as valve and bypass surgery, during a Jivo Healthcare masterclass for doctors across Africa.
From Major Open Surgery to a Small Puncture
Aneurysm surgery used to mean a major operation to open and repair the artery directly. Today, a small tube, a stent, can be placed inside the aneurysm through a single puncture in the leg, without any incision at the site of the aneurysm itself. Dr. Kaul showed the angiogram of one such case: a normal artery next to the same artery ballooned into an aneurysm, followed by the same vessel after the stent had been placed. The patient in that case was discharged within 24 hours.
The Same Principle Applies to the Carotid Artery
Asked directly whether the same minimally invasive approach extends to a carotid artery aneurysm, Dr. Kaul confirmed that it does, with one condition: a CT angiogram of the carotid artery first needs to show that a stent can actually be placed there. When that is confirmed, treatment again requires only a single small puncture rather than open surgery.
Why This Matters for Referral Decisions
For a referring doctor without access to endovascular treatment locally, the practical takeaway is that a diagnosed aneurysm, aortic or carotid, is not automatically a case for major open surgery. A CT angiogram showing the anatomy is suitable for a stent can turn what looks like a high-risk operation into a same-day, minimally invasive procedure.
This guide is based on a live Jivo Masterclass: Dr. Ajay Kaul taught doctors across Africa on December 1, 2024.
FROM THE LIVE Q&A
Moderator
Can the same minimally invasive technique be used for a carotid artery aneurysm?
Dr. Ajay Kaul
Yes, if the CT angiogram of the carotid artery shows that a stent can be placed, the aneurysm can be treated with an intravascular stent through a single small puncture in the leg, making it a minimally invasive procedure.
Frequently Asked Questions
Following up on the complications of artificial heart transplantation, what about a further concern he described as 'autonomic surgery' in this context?▼
Dr. Kaul reiterated the transplant complications he had already covered, then said that there was nothing called autonomic surgery that he was aware of, and that the term appeared to be a translation error. The exchange closed with a request for Dr. Kamba to put the question in writing in the chat so it could be understood correctly.
Are there any techniques available for treating tetralogy of Fallot?▼
Tetralogy of Fallot is very well treatable, and children who are operated on go on to lead a normal life. I have patients who are now 25 to 30 years old and doing very well. Depending on the exact type of tetralogy, the results are very good.
How does an artificial heart actually work?▼
The heart is essentially a pump: blood comes in from the body, is pushed to the lungs to be purified, and is then pushed back out to the body. Building an artificial pump that does not damage or clot the blood took nearly 50 years to perfect. The device is based on magnetic levitation technology, similar to Japan's high-speed trains that run without touching the rails, so the pump's rotor never actually makes contact with the blood it is moving. In India, one artificial heart costs around 1.5 crore rupees, which is the major cost barrier.
Is heterozygous (mismatched donor-recipient) heart transplantation possible?▼
It is technically possible, but very few doctors would attempt it. A heart is a precious, scarce organ with a long waiting list of patients, so we always give it to the best-matching recipient rather than risk it in a less compatible match where rejection is more likely.
What happens to the donor in a heart transplant?▼
The donor is already dead by the time of donation. It is not a live donation, so nothing happens to the donor.
How is an aortic aneurysm treated without open surgery?▼
A stent can be placed inside the aneurysm through a single small puncture in the leg, and some patients are discharged within 24 hours.
Can a carotid artery aneurysm be treated the same way?▼
Yes, provided a CT angiogram of the carotid artery confirms that a stent can be placed there.
What determines whether an aneurysm can be treated with a stent instead of surgery?▼
The artery's anatomy, confirmed on a CT angiogram, has to be suitable for stent placement.
In This Series: Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
- 1.Transforming Cardiac Care
- 2.Minimally Invasive Cardiac Surgery: A New Standard for Heart Operations
- 3.Valve Replacement and Coronary Bypass Surgery Without a Full Sternotomy
- 4.Treating Aortic and Carotid Aneurysms With a Minimally Invasive Stent
- 5.Heart Failure and the Case for Heart Transplantation
- 6.The Artificial Heart (LVAD): A Bridge to Transplant
- 7.Tetralogy of Fallot and Eisenmenger Syndrome: Two Very Different Outcomes
- 8.A Cardiac Surgeon's Guide to Preventing Heart Disease