Coronary Heart Disease (cont.)
Medical Treatment: Invasive Procedures
When angina symptoms worsen despite medications, you may
need an invasive procedure in the cardiac catheterization lab to clear the
blocked artery. These procedures are performed by a cardiologist, not a cardiac
surgeon, and have fewer complications.
Coronary angioplasty (PTCA): This procedure is similar to coronary angiography (cardiac catheterization or a dye study to visualize the inside of coronary arteries) but is therapeutic as well as diagnostic.
- A similar but sturdier tube (guide catheter) is inserted into an artery in your groin or arm, and a hair-thin guide wire is threaded through it into your coronary artery.
- A much thinner catheter is threaded over the guide wire into the blocked artery.
- This thinner catheter has a tiny balloon at the end.
- Once the balloon is positioned at the blockage, the balloon is inflated to widen your artery and improve blood flow. The plaque is still there, just flattened against the wall of the artery.
- The balloon catheter is then withdrawn.
- This procedure is sometimes referred to as PTCA, which stands for its full formal name: percutaneous (through the skin) transluminal (through the hollow center of the blood vessel) coronary angioplasty.
Stent: A stent is a small, sieved, coil-like metallic tube or scaffold mounted over a balloon.
- The balloon is inflated at the blockage, which expands the stent.
- The balloon is then withdrawn, but the stent stays in place, keeping the artery from narrowing again.
- Like arteries treated with angioplasty alone, arteries treated with a stent can eventually close up again.
- The stent is a longer lasting solution for many people.
Atherectomy: Sometimes the plaques become too rigid, bulky, or calcified to be treated with angioplasty or a stent.
- In such cases, the plaques must be removed by cutting with a drill-like device.
- This works only if the narrowing or blockage is limited to a relatively small and self-contained portion of an artery.
- Devices commonly used for atherectomy include directional atherectomy (DCA) catheter, rotational atherectomy or rotablator (PTRA), transluminal extraction catheter (TEC), or AngioJet.
- Plaques also may be burned away with an excimer laser atherectomy (ELCA).
Radiation is applied to the blockage to clear it.
- The radiation comes from a very tiny source placed inside or near the artery.
- This procedure is used to treat arteries that have undergone angioplasty or stenting but have blockage that keeps coming back (restenosis).
Vibhuti N Singh, MD, MPH, FACC, FSCAI
Francisco Talavera, PharmD, PhD
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