|
Nonsurgical options
If a diagnostic catheterization reveals significant CAD, your and your doctor will need to discuss treatment options. The following are considered nonsurgical because they are done through a tube or catheter instead of through a long incision.
Conventional balloon angioplasty: In this procedure, blocked coronary arteries are reopened by inflating a tiny balloon inside the blockage, compressing the fatty plaque against the artery walls and widening (dilating) the vessel.
Angioplasty with stenting: In most cases, angioplasty is generally combined with a procedure called stenting, in which a tiny tube of metal mesh, or stent, is used as a scaffold to help keep the artery open. It usually is placed over an angioplasty balloon, and the assembly is pushed into a narrowed artery and the balloon is inflated, expanding the stent. The balloon is then deflated and withdrawn. Over a period of several weeks your artery heals around the stent.
Stents, too, can become blocked. However, stents coated with a drug—called drug eluting stents—discourage reblocking, or restenosis. These have restenosis rates of less than 10 percent. Almost all stents implanted now are drug-coated.
Other drugs have been developed to stop reblocking before it starts. As one of the initiating steps in restenosis, platelets (tiny particles in the blood) collect at the site and promote clotting (thrombosis). Drugs called glycoprotein IIb/IIIa inhibitors block the chemical that encourages the platelets to collect. The glycoprotein IIb/IIIa inhibitors may be given intravenously (IV) just before the intervention and then continuously for a period of time, depending on which is used.
Angioplasty, with or without stenting, is often raised as a treatment possibility even before a diagnostic catheterization, so that the diagnostic procedure can proceed directly to treatment while you are in the cath lab, if warranted. Also, angioplasty and stenting may be combined with the use of other specialized procedures or catheters, including:
Rotoblation (percutaneous transluminal rotational atherectomy, or PCRA): In this procedure, a special catheter with an acorn-shaped diamond-coated tip is guided to the narrowing in your coronary artery. The tip spins at a high speed and grinds up the plaque on your arterial walls. The microscopic particles are safely washed away in your blood stream and filtered out by your liver and spleen.
Cutting balloon: A balloon tip with small blades is inserted through the catheter and moved to the narrowing in the artery. When the balloon is inflated, the blades are activated. After the small blades score the plaque, the balloon compresses the fatty matter into the artery wall.
Although the above treatments are considered nonsurgical, they entail risks and require special expertise. Ask your doctor and hospital how many such procedures they perform each year. According to American Heart Association guidelines published in 2001, hospitals should perform at least 400 percutaneous coronary interventional (PCI) procedures each year.
Learn more about what to expect and the recovery process.
|
