Every Blocked Artery Doesn't Need The Same Answer - Dr. Manjunath Suresh Pandit

Heart attacks are no longer confined to older adults. Across India, cardiologists are seeing men and women in their thirties and forties arriving with blocked coronary arteries, driven by diabetes, hypertension, high cholesterol, tobacco use, chronic stress, poor sleep and sedentary lifestyles. Many ignore early symptoms such as chest discomfort or breathlessness, attributing them to acidity, fatigue or work pressure until a life-threatening event occurs.

This changing pattern of disease is forcing hospitals to rethink cardiac care. Success is no longer measured only by restoring blood flow during an emergency, but by choosing the treatment that offers the safest and most durable outcome for each individual.

At Kauvery Hospital, Marathahalli, this approach defines the Cardiac Sciences programme. Every complex coronary intervention begins with understanding the patient, the artery and the disease before selecting the most appropriate treatment.

That philosophy was put into practice when a 34-year-old woman arrived shortly after 1 a.m. with severe chest pain. Although younger women generally have a lower risk of coronary artery disease before menopause, cardiologists are increasingly treating younger women with heart attacks, influenced by diabetes, hypertension, smoking, metabolic disorders and changing lifestyles.

An emergency coronary angiogram revealed one of the three major arteries supplying blood to her heart completely blocked by cholesterol-rich plaque and fresh blood clots.

Restoring blood flow was the immediate priority. The next decision was more important.

Would the artery require a drug-eluting stent, the global standard for most acute heart attacks, or could it be managed differently?

After detailed imaging and lesion assessment, The objective was not only to restore blood flow, but wherever clinically appropriate, to restore the artery as close as possible to its natural size and function, including specialised balloon preparation where required, the team treated the artery using a drug-coated balloon, an approach commonly known as stentless angioplasty.

Unlike a drug-eluting stent, which remains permanently inside the artery while gradually releasing medication, a drug-coated balloon delivers medication directly into the artery wall before being removed. The medication helps prevent excessive tissue growth that can contribute to the artery narrowing again, reducing the likelihood of recurrence at the treated site in appropriately selected patients.

This treatment is not suitable for everyone. Factors such as vessel size, plaque characteristics, calcium burden, blood clots and the patient's overall clinical condition determine whether drug-coated balloon therapy is appropriate. For many patients, particularly those with acute heart attacks and complex coronary disease, drug-eluting stents remain the standard of care.

The patient recovered well and was discharged within three days.

Her story is significant not because a stent was avoided, but because the treatment was selected after understanding the artery rather than following a routine pathway.

Modern coronary intervention has evolved beyond a single-device approach. Depending on the characteristics of the blockage, cardiologists may use cutting balloon technology to prepare resistant or calcified lesions, drug-coated balloon therapy in carefully selected patients, or drug-eluting stents where a permanent scaffold offers the safest long-term outcome. In some cases, coronary artery bypass surgery remains the preferred option.

Making these decisions requires more than a conventional angiogram. At Kauvery Hospital, Marathahalli, technologies such as Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) allow cardiologists to assess plaque composition, vessel dimensions and lesion complexity with remarkable precision before deciding the most appropriate treatment.

This evolution is particularly relevant for India, where coronary artery disease develops nearly a decade earlier than in many Western populations. As the burden of premature heart disease grows, hospitals must combine advanced technology with sound clinical judgement.

At Kauvery Hospital, this philosophy extends across the entire Cardiac Sciences programme. Emergency cardiac care, advanced coronary imaging, complex coronary interventions, structural heart therapies and multidisciplinary expertise work together to ensure that treatment is personalised rather than standardised.

According to Dr. Manjunath Suresh Pandit, Consultant Interventional and Structural Cardiologist, "Drug-eluting stents remain the standard treatment for most patients with acute heart attacks and complex coronary artery disease. Advances in coronary intervention, including cutting balloon technology and drug-coated balloon therapy in carefully selected patients, have expanded our treatment options. The medication delivered through the drug-coated balloon helps prevent the artery from narrowing again at the treated site. The objective is never to avoid stents. The objective is to ensure every patient receives the safest and most durable treatment based on scientific evidence and the unique characteristics of that artery."

For Kauvery Hospital, Marathahalli, innovation is not measured by adopting every new technology. It is measured by knowing which technology will deliver the greatest benefit for each patient. Every blocked artery may not need the same answer. Every patient, however, deserves the right one.