Why Do I Need One
When Surgery Is Needed
Disease in the coronary arteries predisposes you to blood clots, which may block the blood flow to the heart muscles or travel to the brain and interrupt blood flow, resulting in a stroke.
If you are diagnosed with CAD, it is vital that you receive appropriate treatment to reduce your risk of these life-threatening complications.
Medical therapies include prescription blood thinners, high cholesterol treatments, antihypertensives, and medications that help manage heart disease. But, often, these aren’t enough to reverse CAD.
In these cases, the diseased blood vessels may need to be surgically repaired. For people who have symptoms of CAD, and even for some who don’t experience symptoms, a procedure can decrease the risk of death compared to medical therapy alone.
Revascularization is a process by which a severely diseased artery is cleared of blockage through an interventional procedure. Areas of significant obstruction in the coronary arteries can be opened with angioplasty and stent placement or with coronary artery bypass grafting .
Angioplasty Is A Specialised Treatment To Unblock Narrowed Or Blocked Coronary Arteries And Increase The Blood Flow To The Heart Muscle
It involves threading a tiny balloon up to the area which is narrowed and temporarily inflating the balloon to widen the artery. Angioplasty is also known as percutaneous coronary intervention , Percutaneous Transluminal Coronary Angioplasty .
Angioplasty is often combined with the placement of a stent or stents. A stent is a small wire tube which is expanded in the coronary artery and permanently helps to prop the artery open. Some stents are coated with medication to help keep your artery open , while others are not .
Surgery For Blocked Arteries Is Often Unwarranted Researchers Find
Drug therapy alone may save lives as effectively as bypass or stenting procedures, a large federal study showed.
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By Gina Kolata
The findings of a large federal study on bypass surgeries and stents call into question the medical care provided to tens of thousands of heart disease patients with blocked coronary arteries, scientists reported at the annual meeting of the American Heart Association on Saturday.
The new study found that patients who received drug therapy alone did not experience more heart attacks or die more often than those who also received bypass surgery or stents, tiny wire cages used to open narrowed arteries.
That finding held true for patients with several severely blocked coronary arteries. Stenting and bypass procedures, however, did help some patients with intractable chest pain, called angina.
You would think that if you fix the blockage the patient will feel better or do better, said Dr. Alice Jacobs, director of Cath Lab and Interventional Cardiology at Boston University. The study, she added, certainly will challenge our clinical thinking.
This is far from the first study to suggest that stents and bypass are overused. But previous results have not deterred doctors, who have called earlier research on the subject inconclusive and the design of the trials flawed.
With its size and rigorous design, the new study, called Ischemia, was intended to settle questions about the benefits of stents and bypass.
Difference Between Open Heart Surgery And Angioplasty
Key Difference: Open heart surgery deals with the structures inside the heart. In an open-heart surgery, a large incision in the chest is made to open the rib cage. A heart-lung machine is required in an open heart surgery. An angioplasty is a procedure in which coronary arteries are unblocked. An angioplasty procedure does not require an open heart surgery.
Open heart surgery is traditionally associated with the types of surgery that involves cracking the walls of the chest. However, the other types of open heart surgery includes less invasive surgeries in which small incisions are made between ribs. In broad context, it refers to a type of surgery that involves repairing or fixing structures that are located inside the heart. In this type of surgery, the chest wall is surgically opened and the heart is exposed. “Open” refers to the chest not the heart. However in few cases, surgeon may also open the heart. This surgery is performed on the muscles, valves, or arteries of the heart. The function of the heart during this surgery is conducted by a heart-lung machine. During this surgery, heart beats are temporarily stopped and the demand of oxygen is fulfilled by a heart-lung machine. Special tubes called cannular are placed in the veins as well as in the arteries of the heart. A variant of open heart surgery is known as the beating heart surgery. In this type of surgery, the heart is not stopped from beating.
Comparison between Open Heart Surgery and Angioplasty:
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How Is A Stent Performed
There are several ways to insert a stent.
Your doctor usually inserts a stent using a minimally invasive procedure. They will make a small incision and use a catheter to guide specialized tools through your blood vessels to reach the area that needs a stent. This incision is usually in the groin or arm. One of those tools may have a camera on the end to help your doctor guide the stent.
During the procedure, your doctor may also use an imaging technique called an angiogram to help guide the stent through the vessel.
Using the necessary tools, your doctor will locate the broken or blocked vessel and install the stent. Then they will remove the instruments from your body and close the incision.
Any surgical procedure carries risks. Inserting a stent may require accessing arteries of the heart or brain. This leads to an increased risk of adverse effects.
The risks associated with stenting include:
- an allergic reaction to medications or dyes used in the procedure
- breathing problems due to anesthesia or using a stent in the bronchi
- an infection of the vessel
- kidney stones due to using a stent in the ureters
- a re-narrowing of the artery
If you have bleeding issues, you will need to be evaluated by your doctor. In general, you should discuss these issues with your doctor. They can give you the most current information related to your personal concerns.
What Are The Risks Of Coronary Angioplasty
Coronary angioplasty is a common medical procedure. Although angioplasty is normally safe, there is a small risk of serious complications, such as:
- Bleeding from the blood vessel where the catheter was placed.
- Damage to blood vessels from the catheter.
- An allergic reaction to the dye given during the angioplasty.
- An arrhythmia .
- The need for emergency coronary artery bypass grafting during the procedure . This may occur when an artery closes down instead of opening up.
- Damage to the kidneys caused by the dye used.
- Heart attack .
- Stroke .
As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than two percent of people die during angioplasty.
Sometimes chest pain can occur during angioplasty because the balloon briefly blocks off the blood supply to the heart.
The risk of complications is higher in:
- People age 75 years and older
- People who have kidney disease or diabetes
- People who have poor pumping function in their hearts
- People who have extensive heart disease and blockages
Research on angioplasty is ongoing to make it safer and more effective, to prevent treated arteries from closing again and to make the procedure an option for more people.
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Should You Have Stenting Or Bypass Surgery
Many factors go into your physician’s recommendation.
When fatty plaques threaten to obstruct the coronary arteries, there are two options for restoring blood flow : open the blockages with a balloon , followed by the placement of a stent or bypass the blockages with coronary artery bypass grafting .
Balloon angioplasty can open a narrowed artery, and the stent can hold it open. Angioplasty and stenting is a minimally invasive, nonsurgical procedure with less postoperative pain, a shorter hospital stay, and faster recovery than CABG. So it’s no surprise that its popularity has soared. But despite these advantages, it’s not the best choice for everyone. Now that thousands of stents have been implanted, cardiologists better understand the long-term effects of the procedure and can make an informed decision about which treatment might be best for each individual.
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What Happens After The Procedure
Recovery from an angioplasty and stent implantation is usually fast. Most patients can resume normal activities 24 hours after the procedure. Some people experience bruising, which will disappear in a few days.
Due to a heightened risk of clotting after stenting, treatment with Aspirin AND antiplatelet drugs is required for at least one year. Among the possible antiplatelet drugs your cardiologist may prescribe are clopidogrel or ticagrelor . Make sure you understand the dosage and duration of the medications as detailed by your doctor. Do not stop these medications without consulting your cardiologist.
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Instructions After The Procedure
A responsible adult MUST drive you home. You will not be discharged unless there is someone available to drive you home.
If you have more than a two-hour drive home, we suggest that you stay overnight in a hotel for your comfort. The Medical Concierge can help you make arrangements. Then have your family member drive you home the next morning, after you have rested.
During your drive home, stop every hour and walk for 5 to 10 minutes. If you are traveling home by plane, stand up to stretch your legs and walk in the aisle at least every hour.Please ask your doctor when you can resume driving.
How Do I Manage Post
A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery. Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.
Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:
- Nerve blocks
- Lidocaine infusion
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Heart Blockage Moderate Coronary Artery Disease
A moderate amount of heart blockage is typically that in the 40-70% range, as seen in the diagram above where there is a 50% blockage at the beginning of the right coronary artery. Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms. Moderate coronary artery disease is treated much in the same way as mild disease, basically attention to risk factors, medications, and healthy lifestyle modification. Occasionally, heart blockage at the higher end of the moderate range may require additional testing to see if it is significant or not and may be responsible for symptoms.
What Is The Stenting Procedure
Stents are placed during a coronary angiogram. A small tube called a balloon catheter is inserted into the femoral artery or the radial artery , and advanced toward the heart to the very top of the aorta. After the blockage is identified, a wire is placed into the coronary artery to the site of the blockage and the stent is loaded on to the wire. The stent is expanded to the size of the artery and may be expanded by inflating a balloon within the stent. Then the wires are removed along with the catheter, while the stent stays in the artery permanently.
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Who Needs A Stent
Stents are used to reduce symptoms in patients with obstructive artery disease who suffer chest pain/tightness or shortness of breath that might be experienced with exercise or during periods of strong emotions. Stents may be used instead of bypass surgery in some selected patients. Diabetic patients with multiple coronary blockages may do better with bypass surgery.
Meeting With Your Doctor
If your angioplasty isn’t done as emergency treatment, you’ll meet with your doctor before the procedure. Your doctor will go over your medical history , do a physical exam and talk about the procedure with you. Your doctor also will order some routine tests, including:
- Blood tests
- A chest x-ray
When the procedure is scheduled, you will be advised:
- When to begin fasting before the procedure. Often you have to stop eating or drinking by midnight the night before the procedure.
- What medicines you should and shouldn’t take on the day of the angioplasty.
- When to arrive at the hospital and where to go.
Even though angioplasty takes one to two hours, you will likely need to stay in the hospital overnight. In some cases, you will need to stay in the hospital longer. Your doctor may advise you not to drive for a certain amount of time after the procedure, so you may have to arrange for a ride home.
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What Happens During Angioplasty
Angioplasty may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices. Most people who have angioplasty and stent placement are monitored overnight in the hospital.
Generally, angioplasty follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.
You will be asked to remove your clothing and will be given a gown to wear.
You will be asked to empty your bladder before the procedure.
If there is a lot of hair at the area of the catheter insertion , the hair may be shaved off.
An IV line will be started in your hand or arm before the procedure. It will be used for injection of medicine and to give IV fluids, if needed.
You will be placed on your back on the procedure table.
You will be connected to an electrocardiogram monitor that records the electrical activity of your heart and monitors your heart rate using electrodes that stick to your skin. Your vital signs will be monitored during the procedure.
There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through your body into your heart, and the structures of your heart as the dye is injected.
You will get a sedative in your IV to help you relax. However, you will likely stay awake during the procedure.
Minimally Invasive Heart Surgery
and Minimally Invasive Coronary Artery Bypass Graft
What the Procedure Does
An alternative to standard bypass surgery . Small incisions are made in the chest. Chest arteries or veins from your leg are attached to the heart to “bypass” the clogged coronary artery or arteries. The instruments are passed through the ports to perform the bypasses. The surgeon views these operations on video monitors rather than directly. In PACAB, the heart is stopped and blood is pumped through an oxygenator or “heart-lung” machine. MIDCAB is used to avoid the heart-lung machine. It’s done while the heart is still beating. Requires several days in the hospital.
Reason for the Procedure
- Manages blockage of blood flow to the heart and improves the supply of blood and oxygen to the heart.
- Reduces risk of heart attack.
- Improves ability for physical activity.
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Aortic Aneurysm Or Dissection
Your doctor may use a stent graft to treat an aneurysm or dissection, or tear, of the aorta. The stent graft supports the weak area of the aorta and helps to prevent the aneurysm or dissection from bursting. Stent grafts can also help to treat injuries that have weakened the aorta. Blood flows through the stent graft and prevents blood from leaking into the body.
Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Servicesâ National Institutes of Health âthe Nationâs biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.
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Cabg Best For Most Important Artery
The heart’s three coronary arteries are not all equal. The most important artery is called the left anterior descending artery . It feeds blood to the whole front wall of the heart, which represents much more muscle than the area fed by either of the other two coronary arteries. A narrowing or blockage in the LAD is more serious than narrowing or blockage in the other arteries.
“If you have two blocked vessels and one is the LAD, especially the upstream portion, the data support bypass surgery, but not as convincingly as for the patient with three-vessel disease,” Cutlip says. “There are issues like whether both vessels can be easily treated with stents, or whether the patient has other risk factors.”
One major factor is that LAD bypass uses another arterythe mammary artery, located in the chest near the heartfor the graft. Complications are rare, and CABG using the mammary artery lasts for decades. Moreover, for reasons still unknown, the mammary artery is nearly immune to blockage.
“If put you put a stent in the LAD, you are only protecting that area of blockage, and the rest of that artery is still vulnerable,” Cutlip says, “whereas a bypass will protect the downstream portion of that vessel probably forever.”
Coronary heart arteries