Angioplasty and Surgery for Heart Disease
Medical Procedures for removing plaque
• Coronary artery bypass
Coronary Artery Bypass
A Coronary Bypass is now pretty much a routine surgical procedure in many Hospitals. It’s quite a simple procedure, a segment of healthy blood vessel, usually a chest artery or a vein from the leg is grafted to bypass blocked segments of the coronary arteries.
Usually after surgery 2-3 days are spent in an intensive care recovery unit with another few days required in the hospital.
When a Bypass is necessary and based on accepted criteria, the procedure increases long term survival and symptom relief for 85% of patients. The controversy as to when it is appropriate differs among the most respected of physicians.
Although this procedure greatly improves how most people feel, it does not cure heart disease, so unless preventive steps are taken, the processes that originally caused the disease will continue. Following a Bypass it is important for patients to make lifestyle changes.
Angioplasty is used to widen the arteries in the heart that are narrowed or blocked due to a formation of plaque. The technique used will depend on where the blockage is, its shape, and whether it is hard or soft plaque.
Angioplasty offers a few advantages over coronary bypass surgery,although invasive, it does not require use of a heart lung machine as it is performed under local anesthetic,it is also not as costly to perform, generally only one or two days in Hospital are required.
The procedure involves threading a catheter into the affected artery to the blocked area, it has a balloon like tip . The balloon is inflated which in turn flattens the fatty deposits and widens the arterial channel allowing more blood to reach the heart muscle.
Laser angioplasty uses a catheter with a laser tip rather than a balloon tip. The catheter is guided to the blockage and the laser tip is used to destroy the plaque. Lasers have been used with angioplasty and bypass procedures but the risks have been high and the treatment is expensive.
Angioplasty can also be used in blocked arteries in the legs and the carotid arteries in the neck, the major vessel carrying blood to the brain. However angioplasty may be appropriate for all individuals.
Standard angioplasty can have it’s complications because the procedure traumatizes the vessel wall. Damaged cells try to heal which forms scar tissue that re clogs the artery. Six to nine months after treatment, restenosis recurs in leg arteries (50-60%) and in the heart arteries (20-30%). The procedure is often repeated or surgery is performed instead although the use of stents has improved the odds to a favorable outcome.
A stent is a tube usually made from a stainless steel type mesh. Once the artery has been widened by an angioplasty procedure, a stent catheter is threaded into the artery and placed around a deflated balloon. When the balloon is is inflated it expands the stent against the artery walls, the balloon catheter is removed but the stent is left in place to hold the artery open.
Specialized devices are used to cut away plaque, particularly blockages that are too hardened for balloon angioplasty. A tiny rotating blade trims away plaque on the inside of artery walls.
Chest pain is the most common complication of atherectomy, but other complications may include injury to the blood vessel lining, restenosis, blood clots, and bleeding at the site of insertion. More serious but less frequent complications are holes, tears, or reduced blood flow to the heart. It is estimated that atherectomy is successful about 95% of the time, however plaque reforms in 20-30% of patients.