Blocked Heart Arteries: Top 5 Treatment Options
How should heart disease be treated? By drugs, balloons, drills, lasers or operation. Dr. O.P Yadava and Dr. Ajit Bana discuss which methods to use and when
Depending on the degree of blockage, the patient may experience varying degrees of chest discomfort, called angina, during physical exertion. Even a heart attack may occur if blood flow in a coronary artery is suddenly cut off completely, usually by a blood clot that forms on a plaque.
Drugs, Balloons and Surgery
There are various ways to treat the narrowing in coronary arteries. If the symptoms are mild, the doctor may give medicines that reduce the heart's demand for oxygen or cause blood vessels to relax and widen. But, what if symptoms are not sufficiently helped by medicines?
Previously, the only option was bypass surgery to re-route blood flow around the blockage. Today, there are non-surgical alternatives that open blocked arteries. Coronary angioplasty with a balloon and placement of a stent or other device is the most common alternative.
The cardiologist (heart specialist) may refer to this as percutaneous transluminal coronary angioplasty (PTCA). Percutaneous means through the skin, transluminal means inside the blood vessels, coronary means vessels supplying the heart, and angioplasty means blood vessel repair.
In most cases, a device called a stent has been used in recent years. A stent is a fine metallic mesh coil that is inserted into the artery via a specially designed fine tube. The stent holds the narrowed artery open wider and reduces the likelihood that the artery will become narrowed again.
Some stents are being designed with clot-busting medication, or with radiation, because studies have shown that both may be effective in preventing arteries from narrowing again. Researchers have found that small doses of radiation (called intra-coronary radiotherapy) can reduce the scar tissue that forms around the stent following angioplasty.
Coronary bypass surgery, an alternative to angioplasty, is a major option. An artery from the chest wall or hand or vein from another part of the body is grafted to bypass the blocked heart artery. It redirects blood flow around the blockage to the heart muscle deprived of blood.
Angioplasty vs Bypass Surgery
- Pain and side effects: With angioplasty, there is relatively minor discomfort from having a catheter inserted into the leg or arm artery. The patient must lie flat for about six hours but can be up and walking soon and go home within the next 2-3 days. Bypass surgery traditionally involves splitting the breast bone. Most of the discomfort stems from this and from the incision in the arm or leg, from where the conduits (blood vessels) are taken. The discomfort in the chest, arm and leg lasts for 3-6 weeks.
- Requirement for subsequent procedures: About 20-25% of people who have angioplasty will need to have it repeated within a year, compared to less than 5% of coronary bypass patients who need to have a repeat bypass surgery within a year. That is the down side to angioplasty; it doesn't last very long. But it is easier to repeat if necessary. Surgical bypass lasts an average of 10 to 15 years. Bypass surgery can be repeated with only a very marginal increase in risk.
- Multiple blockages in arteries: Angioplasty can be used for multiple blockages, but the risk of having problems or re-blockage with the angioplasty increases when more blockages are treated. At this stage, the best procedure for these types of blockages is coronary bypass surgery.
- Other associated risks: There is a less than 2% chance that a patient will suffer a heart attack or require emergency bypass surgery during coronary angioplasty. The chances of having a heart attack during bypass surgery is also about 2-3%.
- Mortality rates: The risk of death from either procedure is usually about 1 to 2 per cent, but it depends upon a lot of factors like strength of heart muscles, type of blockage and other risk factors. Various studies show that for many people, coronary angioplasty works as well as bypass surgery to reduce chest pain and improve lifestyle. But coronary artery disease is a very diverse disease, and no two patients are alike and treatments still need to be tailored for specific patients. Some patients are obvious candidates for angioplasty, and some are obviously better candidates for surgery. The decision is made for an individual patient by joint consultation between doctor and patient.
- Beyond the balloon and stents: Scientists continue to look for ways to improve coronary angioplasty. The goal is to reduce complications, lower the frequency of re-blockage, and improve the success rate for less than ideal candidates.
- Directional atherectomy: This is done using a miniature rotating blade to cut out the fatty deposit and remove it from the body. This is only beneficial in about 1 percent of cases.
- Rotational atherectomy: This uses a diamond-studded drill-bit to pulverize blockages. This is particularly useful for calcified, ridge blockages that are present in about 5 percent of cases.
- Lasers: These use tiny laser beams that can vaporize plaques. This is beneficial in less than 1 percent of cases.
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