Dr. Kulin Sheth – Cardiologist in Ahmedabad

Dr. Kulin Sheth - cardiologist in bopal, ahmedabad
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Dr. Kulin Sheth - cardiologist in bopal, ahmedabad
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Advanced Angioplasty for Complex Heart Blockages in Ahmedabad — Apollo CVHF Heart Institute

Not all heart blockages are straightforward. Some are severely calcified — so hard that a conventional balloon cannot open them. Some are located at critical branch points in the artery. Some are in the left main coronary artery — the most important artery in the heart. And some are complete occlusions that have been fully blocked for months or years.

Many patients with these types of blockages are told that bypass surgery (CABG) is their only option. In a significant number of these cases, that is not true. With the right expertise, the right imaging technology, and the right advanced techniques, it is often possible to treat these complex blockages with angioplasty — avoiding open-heart surgery entirely.

Dr. Kulin Sheth specialises in advanced and complex coronary interventions at Apollo CVHF Heart Institute, Bodakdev, Ahmedabad. He has experience treating difficult cases that other operators decline — and does so with a thoughtful, evidence-based approach.

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When Is a Blockage Considered 'Complex'?

A blockage is considered complex when it has one or more features that make standard angioplasty technically challenging or risky:

  • Heavy calcification — calcium deposits within the artery wall make the vessel rigid and difficult to dilate with a conventional balloon
  • Left Main Coronary Artery (LMCA) disease — the left main artery supplies the majority of the heart's blood supply, making blockages in this location particularly high-risk and technically demanding
  • Bifurcation lesions — blockages at the point where an artery divides into two branches, requiring specialised techniques to treat both vessels
  • Chronic Total Occlusions (CTO) — arteries that have been completely blocked for more than 3 months, requiring advanced wiring techniques to cross the blockage
  • Long or diffuse disease — blockages spanning a large portion of the artery
  • Previously placed stents that have re-narrowed (in-stent restenosis)
  • Post-bypass graft disease — blockages in coronary artery bypass grafts
Advanced Angioplasty for Complex Heart Blockages in Ahmedabad
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Advanced Technologies Used

Treating complex blockages safely and effectively requires more than standard equipment. Dr. Sheth uses a range of advanced imaging and therapeutic technologies:

Intracoronary Imaging — Seeing Inside the Artery

  • IVUS (Intravascular Ultrasound) — a miniature ultrasound probe on a catheter that provides detailed cross-sectional images of the artery from inside. IVUS precisely measures the size of the artery, the extent and distribution of calcium, the degree of stent expansion, and the presence of complications. It guides optimal stent sizing and deployment — significantly improving outcomes.
  • OCT (Optical Coherence Tomography) — a light-based imaging technology providing even higher-resolution images of the artery wall than IVUS. OCT can identify fine structural details such as plaque characteristics, tissue coverage of previously placed stents, and the precise edges of a blockage. It is the gold standard for assessing stent deployment quality and diagnosing the cause of stent failure.
Using IVUS and OCT rather than relying on X-ray alone allows Dr. Sheth to make more precise treatment decisions — leading to better stent placement, fewer complications, and improved long-term outcomes.

Advanced Treatment Techniques — Breaking Through Difficult Blockages

  • Rotablation (Rotational Atherectomy) — a high-speed rotating burr that drills through severely calcified, rock-hard blockages that cannot be opened with a conventional balloon. The burr pulverises calcium into microscopic particles that are safely absorbed by the body, allowing the artery to be dilated and stented effectively.
  • IVL (Intravascular Lithotripsy — Shockwave) — a newer technology that uses sonic pressure waves — similar in principle to kidney stone treatment — to fracture calcium deep within the artery wall. IVL is particularly effective for calcification embedded in the wall rather than on the surface, complementing Rotablation in certain situations. It can be used with a standard balloon catheter and requires less technical complexity than Rotablation in some cases.
  • CTO (Chronic Total Occlusion) Intervention — opening arteries that have been completely blocked for an extended period. CTO angioplasty is one of the most technically demanding procedures in interventional cardiology, requiring specialised guidewires, microcatheters, and techniques such as retrograde crossing (approaching the blockage from the other direction through collateral vessels). Successful CTO recanalization can restore blood flow to areas of the heart that have been starved of oxygen for months or years.
  • LMCA (Left Main Coronary Artery) Intervention — stenting the left main artery requires precise planning, intracoronary imaging (IVUS or OCT), and meticulous technique. In selected patients, LMCA angioplasty is a safe and effective alternative to bypass surgery, particularly in patients at high surgical risk.
  • LMCA (Left Main Coronary Artery) Intervention — stenting the left main artery requires precise planning, intracoronary imaging (IVUS or OCT), and meticulous technique. In selected patients, LMCA angioplasty is a safe and effective alternative to bypass surgery, particularly in patients at high surgical risk.
  • Bifurcation Stenting — treating blockages at branch points using specialised two-stent techniques (such as DK Crush or Culotte) when the side branch cannot be protected with a single stent. Bifurcation intervention requires careful planning and precise execution to achieve a good result in both vessels.

A Word About Bypass Surgery

Bypass surgery (CABG) is an excellent and well-established treatment for coronary artery disease — particularly for patients with multi-vessel disease, diabetes, or severely reduced heart function. It is not the wrong choice for many patients, and Dr. Sheth will always be honest when bypass surgery is genuinely the better option for a particular case.

However, many patients are referred for bypass surgery with complex blockages that can, in experienced hands with the right technology, be effectively treated with angioplasty. The decision between angioplasty and bypass surgery should always be made after a full and honest discussion — with all the options clearly laid out, and with the patient’s preferences and circumstances fully considered.

If you have been told bypass surgery is your only option, a second opinion from an experienced complex PCI operator is a reasonable and worthwhile step before committing to a major surgical procedure.

Location — Where Are Complex Procedures Performed?

Apollo CVHF Heart Institute

  • +91 7096 800 800
  • Pakwan Cross Road, Sarkhej - Gandhinagar Hwy, opp. GNFC Tower, next to l.O.C petrol pump, Bodakdev, Ahmedabad, Gujarat 380059
  • Angiography, Angioplasty, Pacemakers & Devices (ICD, CRT-D), Structural Heart Procedures (ASD/VSD/PDA Closure, TAVI), Complex Coronary Work (LMCA, Bifurcations, IVL, Rotablation)
  • Open 24 hours
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Dr. Kulin Sheth's Approach​

Dr. Sheth is known for a calm, thorough, and patient-centred consultation style. He takes time to listen, never rushes through an appointment, and explains findings clearly so that patients leave with a genuine understanding of their heart health and what needs to be done — if anything.

Patients also appreciate that Dr. Sheth only recommends investigations that are genuinely needed. There are no unnecessary tests, no unnecessary procedures, and no unnecessary alarm.

Complex Doesn't Always Mean Inoperable

Book a consultation or send your angiography for review. +91 9725551563
Call or WhatsApp: +91 9725551563 | Sheth Heart Clinic, Bopal, Ahmedabad

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FAQs

How do I know if my blockage is suitable for complex angioplasty?
A detailed review of your coronary angiography images — and in many cases additional intracoronary imaging with IVUS or OCT — is required to determine whether a complex blockage is technically suitable for angioplasty. Dr. Sheth reviews angiography images from other centres and provides second opinions for patients who have been told bypass is their only option.
Is complex angioplasty more risky than standard angioplasty?
Complex procedures carry a somewhat higher risk than straightforward angioplasty, reflecting the difficulty of the underlying anatomy. However, in experienced hands with appropriate imaging and technique, the risks are carefully managed and the outcomes are very good. Dr. Sheth will provide a frank and honest assessment of the risks and expected outcomes for your specific case before any procedure.
What is the benefit of IVUS or OCT over standard X-ray guidance?
Standard angiography shows only a silhouette of the artery’s inner channel. IVUS and OCT show the actual artery wall from the inside — the distribution of calcium, the true vessel diameter, and the quality of stent deployment. Studies consistently show that angioplasty guided by intracoronary imaging results in better stent expansion, fewer complications, and lower rates of future stent-related events compared to angiography guidance alone.
Can CTO angioplasty restore vision or function to areas of the heart that have been blocked for a long time?
If the heart muscle supplied by a chronically occluded artery is still viable — i.e., hibernating but not permanently scarred — restoring blood flow through CTO angioplasty can lead to meaningful improvement in heart function, symptoms, and quality of life. Viability assessment using echocardiography or cardiac MRI is often performed before CTO intervention to determine whether the muscle is likely to recover.
Does Dr. Sheth accept referrals from other cardiologists for complex cases?
Yes. Dr. Sheth regularly receives referrals from cardiologists and cardiac surgeons across Ahmedabad and Gujarat for complex PCI, CTO intervention, LMCA stenting, and Rotablation. Angiography images and clinical details can be shared for a preliminary opinion before the patient travels.
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