Revolutionizing Heart Care : A Case-Based Insight into Stentless PCI (ELCA + DEB) at Yashoda Hospital

Revolutionizing Heart Care : A Case-Based Insight into Stentless PCI (ELCA + DEB) at Yashoda Hospital Blog

Revolutionizing Heart Care : A Case-Based Insight into Stentless PCI (ELCA + DEB) at Yashoda Hospital

Cardiovascular disease remains one of the top health concerns in India, and Hyderabad is no exception. With an increasingly sedentary lifestyle, stress, and dietary changes, coronary artery disease (CAD) is on the rise—even among younger populations. Amid these challenges, medical advancements are offering hope and healing. One such innovation is Stentless PCI (Percutaneous Coronary Intervention) using Excimer Laser Coronary Atherectomy (ELCA) and Drug-Eluting Balloon (DEB) therapy.

This blog explores a real-life case of a stentless PCI successfully performed at Yashoda Hospital, Hitech City, Hyderabad by Dr. Rajshekhar V, Senior Interventional Cardiologist. We’ll walk you through the patient’s journey, the decision-making process, the cutting-edge procedure, and what it means for cardiac care in Hyderabad.

Case Snapshot: A 60-Year-Old Patient with Advanced CAD

Patient Profile:

  • Age/Sex: 60-year-old male

  • Condition: Acute Coronary Syndrome – Anterior Wall Myocardial Infarction (AWMI)

  • Complication: Moderate Left Ventricular Dysfunction (EF – 30%)

  • Symptoms: NYHA Class III (significant limitation of physical activity)

  • Prior Diagnosis: Coronary Angiogram (CAG) performed at another hospital revealed extensive coronary artery disease, including a totally occluded LAD (Left Anterior Descending artery) and significant blockages in Ramus, OM1, LCX, and RCA.

Diagnostic Insight

Advanced imaging and cardiac MRI confirmed the presence of viable myocardium in the LAD territory, meaning that the affected portion of the heart muscle could still benefit from revascularization. This was a crucial finding—offering the opportunity to restore blood flow without relying on conventional stents.

The Treatment Plan: Why Stentless PCI?

Given the patient’s diffuse calcific disease and risk of complications from conventional stenting, the cardiology team opted for a Stentless PCI approach using:

  • ELCA (Excimer Laser Coronary Atherectomy): A non-thermal laser technique used to ablate complex plaque and thrombus.

  • DEB (Drug-Eluting Balloon): A balloon that delivers antiproliferative drugs to prevent restenosis, eliminating the need for a permanent metallic stent.

This technique is ideal for patients with high-risk profiles or diffuse disease where stenting may not yield optimal results.

Procedure Highlights

Step 1: LAD Recanalization Using Laser Atherectomy

  • Laser Equipment: 0.9 mm ELCA catheter

  • Pulses Delivered: 27,000

  • Settings: Fluency & rate varied from 45/45 to 65/65

  • Duration: 8 minutes

  • Findings: Fibrocalcific disease from ostium to distal LAD (TIMI II flow)

  • Ballooning & DEB:

    • NC Balloon: 2.5 x 15 mm (for pre-dilation)

    • DEB: 3.0 x 30 mm (Essential Pro @ 6 ATM for 60 sec)

Step 2: Ramus Artery Treatment

  • Pre-Dilation: 2.5 x 15 mm NC balloon

  • DEB: 2.75 x 30 mm @ 6 ATM for 60 seconds

Step 3: OM1 Lesion Management

  • Pre-Dilation: 2.25 x 20 mm NC balloon

  • DEB: 2.25 x 40 mm @ 6 ATM for 60 seconds

Result: Revascularization was achieved in LAD, Ramus, and OM1 using laser and balloon-based therapy—without deploying a single stent.

Why Stentless? Understanding the Rationale

Traditional PCI with stents has been the gold standard for years. However, in complex or calcified lesions, especially with high restenosis risk or small vessel diameter, stentless strategies offer several benefits:

Advantages of Stentless PCI:

  • No Permanent Implant: Reduces risks of stent thrombosis and chronic inflammation.

  • Flexibility in Future Interventions: Easier to perform bypass surgery or repeat interventions.

  • Faster Vessel Healing: Natural vessel compliance is preserved.

  • Ideal for High Bleeding Risk Patients: No need for prolonged dual antiplatelet therapy.

  • Prevention of In-Stent Restenosis: Particularly important in diabetic or small-vessel disease patients.

A Hyderabad Milestone in Cardiac Care

Performing such an advanced, precision-guided PCI without any stents marks a significant step forward in the landscape of interventional cardiology in Hyderabad. Yashoda Hospital’s use of IVUS (Intravascular Ultrasound) guidance, laser therapy, and DEB not only exemplifies clinical excellence but also emphasizes patient-centric decision-making.

What This Means for You

If you or a loved one in Hyderabad is dealing with complex coronary disease—especially if advised against stenting or CABG—Stentless PCI may be a viable and effective alternative.

This procedure is particularly valuable for:

  • Elderly patients with multiple co-morbidities

  • Patients with previously failed stents or restenosis

  • Those with diffuse disease not amenable to stenting

  • Individuals concerned about metal implants or lifelong blood thinners

About Dr. Rajshekhar V

Dr. Rajshekhar V is a renowned Senior Interventional Cardiologist at Yashoda Hospital, Hitech City, Hyderabad. He specializes in high-risk PCI, laser atherectomy, and imaging-guided interventions. His expertise in handling complex cases and pioneering non-stent strategies makes him one of the leading cardiologists in South India.

FAQs on Stentless PCI

1. Is Stentless PCI safe?

Yes, when performed by experienced interventional cardiologists in a well-equipped center, Stentless PCI is safe and effective—especially in anatomies where stents may pose risks.

2. What is ELCA and how does it work?

ELCA stands for Excimer Laser Coronary Atherectomy. It uses short-wavelength UV light to break down plaque, thrombus, and calcium without generating heat—making it ideal for complex blockages.

3. How is DEB different from a regular balloon?

A Drug-Eluting Balloon releases medication (like Paclitaxel or Sirolimus) during inflation to prevent restenosis, unlike a plain balloon which only dilates the vessel.

4. Will I need long-term medication after stentless PCI?

Typically, dual antiplatelet therapy is required for a shorter duration (1–3 months) compared to conventional stenting. Your cardiologist will personalize the medication plan.

5. Who is eligible for Stentless PCI?

Patients with:

  • Small vessels

  • Diffuse disease

  • High bleeding risk

  • Prior restenosis

  • Severe calcification

Your cardiologist will evaluate suitability based on angiographic and imaging findings.

6. Is this procedure available at all hospitals in Hyderabad?

Stentless PCI using ELCA + DEB requires specialized equipment and training. Yashoda Hospital, Hitech City is among the few centers in Hyderabad offering this advanced technique.

7. How much does Stentless PCI cost in Hyderabad?

Costs vary depending on complexity, hospital stay, and consumables. On average, it may range between ₹2.5 to ₹4.5 lakhs, slightly higher than conventional PCI due to laser and DEB usage.

8. Are the results long-lasting?

Yes. Studies and real-world experience have shown favorable long-term outcomes, especially when patients adhere to lifestyle changes and follow-up care.

Need a consultation?

📍 Yashoda Hospital – Hitech City, Hyderabad
📞 + 090003 25483
🌐 www.yashodahospitals.com

Stay informed. Stay heart-healthy.