Coronary Artery Disease
In early stages, pharmaceutical treatment combined with changes in lifestyle and a healthy diet may be able to mitigate the symptoms and slow the progress of coronary artery disease (CAD). If the disease is already advanced, the affected coronaries have to be widened mechanically. The cardiologist will recommend a combination of different treatment options based on the symptoms, the findings, and the future risks for the patient related with clinical conditions and concurrent disorders.
These options include:
Medication and lifestyle changes
Minimally invasive treatment: percutaneous coronary intervention
Balloon angioplasty: Stenting, Resorbable scaffold
Bypass surgery: coronary artery bypass graft
In patients with coronary artery disease, the cardiologist usually prescribes drugs to lower blood pressure and the heart’s workload, like beta-blockers, calcium channel blockers, or diuretics. Acetylsalicylic acid (aspirin) and other antiplatelet agents prevent blood clotting. Nitrates can quickly relieve angina pectoris (chest pain). Statins may lower blood cholesterol. Since everyone is different, the cardiologist will develop a customized therapy plan for each patient.
In addition to pharmaceutical treatment, a healthy lifestyle is crucial to prevent or slow the worsening of the disease: patients should quit smoking, exercise regularly and eat a diet low in fat and salt. For overweight patients, losing weight reduces the heart’s workload and lowers the risk of other disorders.
Percutaneous coronary intervention (PCI) is executed through a thin, flexible tube, called a catheter, in a catheterization laboratory (“cath lab”). The cardiologist accesses the vascular system most often via the femoral artery in the groin or other arteries in the arm. Only a tiny cut in the skin is needed to access the vessel. In many cases, PCI is a beneficial alternative to bypass surgery because it only requires local anesthesia and a small incision instead of a large surgical wound. Since the minimally invasive treatment has lower risks and patients are in a better general condition after the procedure, the inpatient stay is much shorter than after bypass surgery. This definition will be taken in conjunction with your doctors, taking into consideration a number of factors related to proposed treatment, concurrent disorders, clinical conditions, etc.
This intervention is performed with a special balloon catheter. A tiny balloon is mounted on top of this catheter. The cardiologist directs the balloon catheter into the narrowing in the coronary artery. There he or she gradually inflates the balloon. In expanding, the balloon pushes the obstructing deposits against the vessel’s walls, and in so doing, widens the affected coronary artery. After deflating the balloon, the catheter is withdrawn from the body. The blood can now flow unhindered through the coronary artery and supply the heart muscle with oxygen.
Stenting is used to prevent an affected coronary artery from re-narrowing. A stent is a tiny mesh-like tube that can be made of different materials. The cardiologist moves the stent (crimped on the balloon) to the affected site in the coronary artery via a balloon catheter. At the target location, the balloon is inflated, thus expanding the stent which locks into place and forms a scaffold for the vessel wall. After that, the balloon is deflated and removed, while the stent remains in the body, keeping the coronary artery open and allowing blood to flow freely again. There are also stents that release medication after implantation in order to prevent inflammations and post-procedural re-narrowing.
Resorbable scaffolds are innovative stents made of materials like polymers or magnesium alloys that dissolve slowly over a period of up to two years. The coronary artery is healed after this period and stays open without any scaffolding. The vessel regains its natural functions and can adapt better to stress. In addition, any necessary future interventions cannot be hampered by a permanent implant.
If a minimally invasive PCI is not possible, the patient will need to undergo open-heart surgery under general anesthetic. This procedure is called bypass surgery or coronary artery bypass graft (CABG). In this method, the obstructed part of the coronary artery is bypassed with a segment of a healthy vessel secured from another part of the patient’s body. Blood can now flow around the blockage. This surgery can be done while the heart is beating (beating heart surgery) or while the heart is stopped and a heart-lung machine controls circulation (arrested heart surgery).
Find out more about the procedures here.