Coronary Artery Disease (Narrow/Blocked Blood Vessels)
What is coronary artery disease?
Coronary artery disease occurs when plaque (cholesterol, fat, calcium and other substances) builds up in the walls of your arteries, causing them to become narrow and restricting blood flow to the heart.
What are the symptoms?
- Chest pain (heaviness, pressure)
- Pain in your arms, neck or jaw
- Rapid or irregular heartbeat
What treatment options are available?
A Selective Coronary Arteriogram (SCA) allows the physician to look at three separate areas of the heart (left coronary artery, right coronary artery and left ventricular chamber) through a contrast media or X-ray used to illuminate the coronaries, for evaluation of blockage in your arteries. An SCA usually lasts one hour. Many patients go home from the hospital the same day, while others stay overnight.
Coronary Artery Bypass Surgery (Open Heart Surgery)
Coronary Artery Bypass Surgery, sometimes referred to as open heart surgery is recommended, if blockages in the arteries cannot be dissolved or removed and blood supply to the heart is greatly decreased.
The purpose of a surgical bypass is to "re-route" blood around the narrowed or blocked section(s) and restore blood flow to all parts of the heart muscle. A blood vessel will be removed from your leg or chest. One end of the vessel will be attached to your heart's aorta; the other end to the coronary artery below the blockage.
Using a heart-lung bypass machine, doctors are able to rest your heart long enough for surgery. The heart-lung machine takes over the functions of the heart and lungs by cleansing and oxygenating the blood and pumping it through the body. After the surgery is complete, your heart and lungs resume this work.
Recently, it has been found that this type of surgery can also be conducted without using the heart-lung machine so long as a tiny portion of the heart, where the repair needs to take place, can be stabilized and quite still. During this minimally invasive bypass surgery, the surgeon can work on the repairs while the rest of the heart beats freely. This procedure has been perfected and is now referred to as "off pump" or beating heart bypass. In most all other ways, the surgery is similar to traditional bypass in that the incision is the same and the new vessel is joined to the blocked artery in the same way. But the fact that the heart is not stopped has many advantages for the patient including, less anesthesia is required because the operation is usually shorter, less need for blood transfusions and the hospital stay is often shorter.
Coronary & Peripheral Arthrectomy
During arthrectomy, a catheter (a thin, soft, flexible tube) carrying a special cutting or grinding device clears the blockage. The physician will be able to use three separate catheters to look at the left coronary artery, right coronary artery and left ventricular chamber. A contrast media or X-ray is used to illuminate the coronaries for evaluation of blockage in your arteries. Your doctor will select the type of arthrectomy procedure best suited to treat your blockage.
Rotational Arthrectomy uses an abrasive burr near the tip of the catheter to grind the plaque into small particles that float harmlessly away in the bloodstream.
Directional Coronary Arthrectomy (DCA) positions the catheter window over the blockage. A rotating blade shaves the plaque and collects it in the catheter tip.
Extraction Arthrectomy uses an abrasive burr near the tip of the catheter to grind the plaque into small particles that are collected on the tip and extracted.
After the athrectomy, your doctor may do an angioplasty using a balloon catheter to compress any remaining plaque against the arterial wall. An arthrectomy usually lasts one to two hours.
A stent is a small metal coil or mesh tube that is placed in a narrowed artery to help improve blood flow to your heart. The stent permanently holds the passageway open and helps reduce the rate of restenosis (renarrowing of the artery). New tissue will slowly grow over the stent and eventually cover it completely. To prevent the growth of cells from re-occluding the artery following angioplasty (balloon procedure that opens arteries), a drug-eluting stent designed to release the drug Sirolimus, may be used. After the stent placement, you may need to stay in the hospital for one to five days and temporarily take anticoagulant medication to help prevent blood clots.
Angioplasty relieves symptoms of coronary artery disease by improving blood flow to your heart. During angioplasty, a catheter (a thin, soft, flexible tube) with a balloon at the tip is inserted into your artery to widen the passageway. The balloon is inflated and deflated several times to compress the plaque against the artery wall. The artery is now open and blood flow to the heart muscle increases.
Endovascular Vein Harvest
Endovascular Vein Harvest uses a small incision and camera to harvest a vein from the patient's leg that will be used to replace blocked vessels of the heart. This minimally invasive procedure replaces an open incision technique and offers fewer incisions, less discomfort, reduced risk of infection and improved recovery time.