Surgical and Other Procedures for Coronary Artery Disease (CAD) and Angina
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If you cannot control ]]>CAD]]> with lifestyle changes and medication, and ]]>angina]]> or other cardiac symptoms persist, your doctor may recommend a revascularization procedure. The following procedures are used to treat coronary artery disease.
Percutaneous Coronary Intervention (PCI)
These ]]>procedures]]> are done to help clear and open arteries that have narrowed. A catheter is inserted into the artery in your groin (or less likely your arm). The catheter, which has a tiny balloon at the tip, is guided into the affected artery using x-ray pictures, displayed on a television monitor that the doctor views. Once in the artery, the balloon is quickly inflated and deflated to stretch open the narrowed portion of blood vessel and restore the passage of blood. Then the balloon and catheter are removed. Under most circumstances, the doctor will place a mesh "inner tube” or stent in the artery to keep it open. The procedure takes about one to two hours to complete, and you will be awake, although sedated, during this time. Newer stents can be used that are coated with a medication to reduce renarrowing of the artery called “restenosis.” These stents are called drug eluting stents.
A study compared PCI plus optimal medical therapy (intensive medications and lifestyle changes) to optimal medical therapy alone in stable heart patients. Researchers found that adding PCI to treatment did not reduce the risk of death, myocardial infarction, or other heart-related events.
Coronary Artery Bypass Graft (CABG)
]]>CABG]]> is open-heart bypass surgery done to help relieve symptoms of heart disease. However, it does not cure heart disease. You still must maintain a healthful lifestyle that includes maintaining or achieving a healthy weight, eating a low-fat diet, not smoking, and possibly, taking medications.
During this operation, a blood vessel (vein) is taken from the leg or chest or wrist and grafted into a diseased artery, bypassing the blocked area. If more than one area is blocked, a bypass can be done for each area (leading to double, triple, or quadruple bypass). The blood can then go around the obstruction to supply the heart with enough blood carrying oxygen to relieve chest pain.
This surgery has typically been done with the patient on cardiopulmonary bypass (CPB), which immoblizes the heart and keeps it still. Newer methods utilize a "beating heart" procedure, whereby CPB is avoided and the surgery is performed with the heart still beating. While the results are encouraging, it is a relatively new procedure. Talk to your doctor about what options are available, and which one might be best for you.
An open CABG is considered major surgery, using ]]>general anesthesia]]> , and the risks and benefits should be carefully discussed with your doctor.
According to a review of 23 studies, patients who received CABG had more angina relief and less need for another, similar procedure than those who received percutaneous coronary intervention (PCI). PCI involves techniques using ]]>balloon angioplasty]]> or ]]>coronary stenting]]> .
Enhanced External Counterpulsation (EECP)
For patients who are not candidates for the revascularization procedures described above but with refractory chest pain, EECP can be utilized. This is a noninvasive procedure in which inflatable bags are wrapped around the legs (like a blood pressure cuff around the arm) and inflated and deflated in concert with the patient’s heart beat. The patient receives 35 one hour sessions over 7 weeks. This treatment has been shown to reduce the frequency of chest pain.
Studies are underway looking at gene therapy to help the heart grow new blood vessels. This is still an experimental procedure.
Braunwald E, Zipes D, Libby P. Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: WB Saunders; 2001
Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Updated February 2009. Accessed June 18, 2009.
4/10/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Mar 26. [Epub ahead of print]
11/7/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20. [Epub ahead of print]
Last reviewed July 2010 by ]]>Michael J. Fucci, DO]]>
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