E. Murat Tuzcu, MD
When functioning properly, your heart pumps about 3,000 gallons of blood throughout your body every day. Coronary artery disease can slow it down though, and that could lead to a heart attack. Cholesterol and fatty deposits, also called “plaque,” can build up on the inner walls of the coronary arteries. This restricts blood flow, making it difficult for oxygen and nutrients to get to the heart. A complete blockage in one or more of the coronary arteries can cause a heart attack. There are several procedures that are used to open blocked coronary arteries. They are called coronary interventional treatment procedures, and E. Murat Tuzcu, MD, of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, answers questions about them.
What are the different kinds of interventional procedures?
There are several different procedures that may be used to open blocked arteries. Using stents (a small metal coil or mesh tube) is the method employed most often. This method involves dilating the narrowed part of the blood vessel using a long and appropriately sized balloon and then delivering the stent, which is crimped on a similar balloon. Sometimes stents that are mounted on balloons can be placed without dilating the artery. In the era before the widespread utilization of stents, procedures aimed to shave off and remove the plaque were frequently used. These included atherectomy, rotablation and cutting balloons. These, however, are used much less frequently now. Before deciding on a procedure, your cardiologist will perform a coronary angiography to determine what will work best for you.
What’s the difference between balloon angioplasties and stents?
During a balloon angioplasty, a specially designed catheter with a balloon at the tip is inserted into the artery. The balloon expands, pushing the fatty matter into the artery wall and stretching the artery open to increase blood flow to the heart. A stent is a mesh tube and balloon that is inserted into the artery. When in place, the balloon inflates, causing the mesh to expand. The balloon is removed but the mesh remains, acting as scaffolding to provide support inside the coronary artery.
What is a drug-eluting stent?
A metal stent that is placed inside the blood vessel is covered by new tissue over time. Sometimes this new tissue is too thick and narrows the space within the stent, creating a blockage. To prevent the exuberant growth of the new tissue, stents covered with special drugs were introduced a few years ago. Drug-eluting stents minimize the new tissue growth, leading to markedly reduced rates of recurrent blockages (restenosis). Although these stents are deployed successfully in many patients, a small percentage of patients run the risk of heart attacks due to clot formation in the stent. The risk is increased if patients stop taking their blood-thinning medications.
How can one expect an interventional procedure to be?
Interventional procedures are performed in a cardiac catheterization laboratory by a specialized cardiologist and a specialized team of nurses and technicians. The procedures usually last about 1 ½ to 2 ½ hours, but the preparation and recovery time add several hours. Patients will likely be at the hospital most of the day and may remain in the hospital overnight.
What happens after the procedure?
Following the procedure, patients should take it easy for a few days. The doctor will give instructions about restrictions on diet and activities and may prescribe medication to reduce any discomfort. For most people, interventional procedures increase blood flow to the heart, diminish chest pain and may decrease the risk of a heart attack, but they do not cure coronary artery disease. Patients still will need to focus on reducing their risk factors and making certain lifestyle changes to prevent future disease development or slow progression.
To make an appointment with a Sydell and Arnold Miller Family Heart & Vascular Institute physician, call 800.884.9551. (If calling from outside the United States, call 001.631.439.1578.)
