Our expert says:
1. Hi Girish: You are correct about angioplasty and bypass surgery, which are palliative and not curative procedures. To answer your questions in more detail:
(a) You are correct: the constituents of “plaque” cannot be diluted and sucked out through the catheter tube, with the exception of clots (thrombus). Thrombus is the cause of most acute coronary syndromes and can often by sucked out at the time of an emergency angioplasty using a special extraction catheter.
(b) The body will tend to reject any introduced biological materials, but stents are usually made of stainless steel and therefore are not “rejected”. However foreign materials tend to cause an inflammatory response followed by scarring, which may cause re-narrowing of the artery. This is why modern stents are coated with a drug to prevent the growth of scar tissue.
(c) No. As mentioned in (a), plaque cannot be extracted through the catheter tube, and careful diet and medication are both necessary once patients have coronary plaque.
(d) Inflation of an angioplasty balloon at high pressure will certainly compress the plaque, and partially relieve the obstruction. However the natural elasticity of the coronary artery wall tends to cause “recoil” which often leads to re-narrowing of the artery within a few months of angioplasty. This is why bare metal and subsequently drug eluting stents were developed, to prevent elastic recoil.
I hope this is helpful. Kind regards
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