Years ago , I remember asking my professor during a balloon mitral valvotomy workshop .
How is that , you are able to puncture the IAS effortlessly and efficiently sir ?
Every thing is in the feel Venkat , he used to say !
What feel ? I used to wonder !
Now , I realise the guide wires and catheters are just an extension of our hand and fingers.
When we tackle CTO lesions we should be able to feel and differentiate the capsule and dimple .
More sensitive hands (Brains) can tell whether the guide wire is poking the vessel wall or the lesion .
Of-course , now we have sophisticated OCT, IVUS, and camera tipped ( Is it really there ?) guide wires to guide us.
Still , a cardiologist who is able to feel the lesion intimately . . . would be a clear winner !
How to feel a lesion ? (Plaque palpation , Hitting the calcium , Feeling the thrombus ! Cuddling the foramen ovale etc )
Key word : Guide wire tactile sensitivity .We are familiar with guide wire torque .Now , a new technology that can transmit the feel of the target lesion , to the hands of the operator would be very much desirable .
Two point discrimination and temporal cortex plays a critical role here. Irrespective of the hard ware used , how the brain perceives touch is going to determine whether you are going to cross a difficult lesion .
Can you electronically amplify tactile feeling like sound amplification ?
It may be possible in near future. But it has other issues like hypersensitiveness
Can a physician with defective cortical sensory system face difficulty in catheter based interventions ?
I have observed at least two cardiologists with diabetes , acknowledging major difficulty to feel the palque and cross the lesion (Due to autonomic neuropathy ?) With many cardiologists rapidly aging , the quest for intervention goes unabated (Still unwilling to quit ! ) one may experience cortical dementia as a hurdle for guide wire manipulation . These issues need to be tested in real world .
Final message
It is fascinating , how the feel of coronary plaque reaches our brain . It is picked by the tip of guide wire , travels about 150cm , handing over the weak signals across the gloved fingers , reaching all the way through cervical spinal cord and spino-thalamic tracts , brainstem and finally to the cortex.
There are multitude of factors that determine the success of complex angioplasties . I realised suddenly , Intact cortical sense could be an important one, among them . Let us train our brain centres for this specific sensation of cath lab hardware . After all , the brain is maneuvering force in any cardaic intervention !
Dr.S.Venkatesan MD 
