When the arteries of the heart (coronary arteries) become blocked with plaque as a result of atherosclerosis, there are several options available to try to open them up, or to reduce the symptoms this blockage causes.
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When coronary arteries are blocked, a condition called angina is often present. This causes varying degrees of chest pain and discomfort, usually when you're exerting yourself in some way.
In the worst case, a heart attack can occur if the blood flow in a coronary artery is suddenly blocked, often as a result of a blood clot which forms on a plaque.
How can this be managed? Medication vs. surgery
If your symptoms are relatively mild, suggesting that the blockage is not too severe, you will be treated with drugs and asked to make some major lifestyle changes. The drugs are designed to either reduce your heart’s demand for oxygen, or to allow your blood vessels to relax and widen.
If you smoke, you must stop immediately. You should also look carefully at your diet – preferably with the help of a dietician – and cut down on fats, lose weight and do supervised exercise.
But some people are not helped by these relatively simple measures. The next step for them is some form of surgery to open the blocked arteries, or to reroute the blood supply around them.
Different options through angioplasty
Angioplasty means blood-vessel repair. For many people this offers a safe and relatively easy way to deal with blocked arteries.
Coronary angioplasty is done under local anaesthesia and is generally no more than mildly uncomfortable. The different procedures take between 30 minutes to two hours and often only require one day in hospital.
The procedure is called percutaneous transluminal coronary angioplasty (PTCA). This means a procedure which goes through the skin, inside a coronary blood vessel, to repair that blood vessel.
A hollow tube called a catheter is inserted into an artery in the groin. The area will have been numbed first with local anaesthetic. The cardiologist is able to watch the position of the catheter using X-ray images on a television screen. The catheter is guided through your arteries until it arrives at the blocked artery in your heart.
A thinner catheter is then inserted through the first catheter. This has a miniature, deflated balloon at its tip. This is carefully threaded through the blockage. Once in position, the balloon is inflated. This widens the artery and improves the flow of blood through the area. The balloon is then deflated and removed.
Stents after PTCA In around 80% of patients, a stent is also used after PTCA. This improves the outcome of the whole procedure, making sure that the formerly blocked artery remains open. Before stents were developed there was a chance that the blocked artery would narrow again – called restenosis.
A stent is a mechanical device which is used to keep a hollow tube open.
A coronary stent is a device which can be used in the arteries of the heart when one or more have been narrowed by a build up of plaque. A stent can be inserted after the narrowed area has been opened up using PTCA. The stent is then inserted to prevent the artery from narrowing again.
A coronary stent looks like a coiled spring. It is inserted into the artery using a catheter.
A stent is intended to remain in place permanently to keep the artery open. It is inserted under high pressure and over time actually becomes incorporated into the wall of the artery, so there is no danger of it moving later.
What about bypass surgery? It used to be the case that the only option available to surgically deal with blocked coronary arteries was coronary artery bypass surgery. However, these newer techniques have replaced this in around half the people with blocked coronary arteries.
A bypass is a major operation. An artery from your chest wall or a vein from your leg, is attached (grafted) to the blocked part of your coronary artery. This then redirects the flow of blood around the blockage, allowing your heart muscle to receive enough blood and so oxygen.
The cost is generally higher than angioplasty, and it requires a fairly long stay in hospital.
However, for some people with blockage of many of the arteries of their heart, it remains the only option.
What are the advantages of angioplasty? For many people, coronary angioplasty is as effective as bypass surgery in reducing chest pain and improving your ability to live a normal life. However, it has not yet been proved that either angioplasty or for that matter, bypass surgery, actually prolong life. In spite of this, the technique is so much more effective than drugs in relieving symptoms, that it is preferred in many cases.
Angioplasty offers around a 98% immediate success rate.
Recovery from the procedure is quick, relatively pain free and much less expensive than bypass surgery.
What are the disadvantages of angioplasty?
In around 10 to 15% of people, the artery opened with PTCA renarrows within six months. It is more likely to narrow again if the blockage was very long or was in a very small artery. However, angioplasty can be repeated, but in some cases bypass surgery will be recommended if this occurs.
The chances of suffering a heart attack or needing an emergency bypass during coronary angioplasty are less than 2%. The risk of dying during the procedure is much less than one percent.
Is angioplasty for you? When you have chest pain and problems with daily life which are not being adequately treated with medication, you will normally be sent to see a cardiologist. He or she will then assess the different treatment options open to you.
You will have a coronary angiogram, which is a technique in which a dye is injected into the arteries of your heart. This allows the cardiologist to see exactly where and how severe blockages in your arteries are.
Around half the people who have blocked coronary arteries are offered angioplasty. The rest are better treated with bypass surgery.
Even relatively mild angina which is controlled by medication can be relieved by angioplasty. It is a question of weighing up the risks, benefits and costs of this procedure rather than remaining on medication and altering your lifestyle.
Remember that lifestyle changes must be made even after angioplasty or bypass surgery. In particular, you must never smoke again.
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