Cardiology

Benign Prostatic Hyperplasia affect more than 40% people of more than 60 years of age and TURP is the common surgical procedure . But there are limitation of this procedure , like it is Not very effective in very large prostate (more than 80 gm) and many patients develops complications , like excessive post operative bleeding , urinary incontinence , stricture and sexual dysfunction.

Recently a new Endovascular approach has been popularized for the management of BPH In which Prostate arteries are being embolized . Results are as good as TURP and no sexual dysfunction and no urinary incontinence .

Ideal Case for Prostate Artery Embolizations are

1. High Risk case for Surgery
2. Patients on Antiplatelets therapy
3. Any case of of BPH who does not want surgery

Ischemic stroke which comprises about 80% of all acute stroke is a devastating condition with a high burden of neurologic disability and death . Systemic therapy with Intravenous Thrombolytic therapy has been shown to be better than conservative care . But among patients with proximal vessel occlusion in the anterior circulation , 60 – 80% of patients die within 90 days after stroke onset or do not regain functional independence despite of thrombolytic therapy , because of its low efficacy . Prognosis in posterior circulation stroke is even worst . The other limitation for IV thrombolysis is time window ie less than 4.5 hours

Endovascular treatment by thrombectomy has shown the best result with good perfusion in 90% of cases with no increase incidence of Intracranial bleeding which is a limitation of thrombolytic therapy. Endovascular treatment is the treatment of choice in current practice of management of stroke .It has the advantage that it can be given in even in late cases also like 8 – 12 hours after onset of stroke , where imaging shows small necrotic core and large ischemic penumbra of brain .

Ideal Patient for Endovascular treatment

1. Large Ischemic stroke
2. Stroke with Diabetes
3. Late presentationy
4. High risk case for Intracranial bleeding with thrombolysis

Acute massive stroke with thrombus in distal Internal Carotid artery and M1 segment of MCA

Following catheter thrombectomy

Retrieved thrombus

Ideal Patient for Endovascular treatment

1. Elective and Primary Coronary Angioplasty
2. Structural Heart Disease Interventions
   1. Balloon Valvotomies
   2. Device closures in ASD , VSD , PDA’s
3. Endovascular Interventions in
   1. Peripheral Vascular angioplasty
   2. Carotid & Renal Angioplasty
   3. Acute Limb Ischemia
   4. Diabetic Foot
   5. Deep Vein Thrombosis
   6. Upper & Lower GI Bleedings
   7. Urogenital Tract Bleeding
   8. Acute Stroke
   9. Uterine Fibroid
   10. Benign Prostatic Hyperplasia
   11. Erectile Dysfunction
4. Cardiac Rhythm Therapy – Pacemakers & ICD’s