Complex coronary angioplasty (multiple arteries, multiple stents)

Complex coronary angioplasty refers to procedures that go beyond a single, straightforward narrowing: disease in several coronary arteries, long lesions requiring several stents, heavily calcified or small arteries. As with a standard angioplasty, the procedure is performed through a catheter inserted most often through the wrist artery (radial approach), sometimes through the groin artery (femoral approach), without opening the chest. The interventional cardiologist prepares the artery with balloons, then deploys one or more drug-eluting stents, small metal mesh tubes coated with a medicine that limits re-narrowing. When the plaque is heavily calcified, dedicated tools can be used to break it up before the stent is placed, such as a rotating burr (rotational atherectomy) or shock waves delivered through a balloon (intravascular lithotripsy). Intracoronary imaging often helps to choose the stent size and to check that the stents are fully expanded. This procedure is offered to patients with extensive coronary artery disease causing angina or reduced blood supply to the heart muscle. The choice between angioplasty and coronary bypass surgery is made case by case by cardiologists and cardiac surgeons together (the "heart team"), taking into account the anatomy of the lesions, heart function, diabetes and general health. Treatment may be carried out in a single session or in several stages. At Clinique Pasteur Tunis, these angioplasties are performed in a latest-generation catheterisation laboratory, with a cardiac intensive care unit on the same floor and a cardiac surgery team on site.