Coronary Artery Disease
Medications and sometimes lifestyle changes, such as quitting smoking or losing weight, can help improve heart efficiency to reduce angina but can't eliminate the plaque blockages. Medications may include cholesterol-lowering drugs, Beta-blockers, nitroglycerin, calcium channel blockers, angiotensin-converting enzyme inhibitors and others.
To remove plaque from arteries, the following procedures are performed:
Angioplasty, also called percutaneous transluminal coronary angioplasty or PTCA, involves inserting a long flexible tube called a catheter into a blood vessel through a small incision in your skin. The catheter has a deflated balloon on its tip. Once the catheter reaches the blocked blood vessel, the balloon is inflated and compresses the plaque against the sides of the blood vessel. The balloon may be inflated and deflated several times. Often, the procedure is done in conjunction with a small metal tube called a stent that is left in the artery to serve as a scaffold to keep the artery open and prevent the plaque from springing back toward the center of the vessel.
Coronary Artery Bypass Graft
Coronary artery bypass graft (CABG) surgery is an operation in which an artery or a piece of vein taken from elsewhere in your body is attached to the blood vessel to detour blood around the blockage. Conventionally, this is done through open-heart surgery. The surgeon makes a large incision and cuts through the breastbone to access the heart; during part of the operation, your heart will be stopped and a heart-lung machine will be used to pump your blood and help you breathe. UCSF offers an alternative minimally invasive bypass surgery in which the surgeon accesses the heart through a small incision without having to cut bones. There's no need to stop your heart, and most patients don't have to be on a heart-lung bypass machine. The recovery time is 10 days to two weeks, compared to the three to four months it typically takes to recover from open-heart bypass surgery. CABG is the most successful and most common major heart surgery in the Western world.
A coronary stent is a small, latticed, high-grade stainless steel tube that is used to hold the coronary artery open and minimize the chance of abrupt closure after angioplasty. It is placed in the coronary artery using the same procedure as the angioplasty. The stent is typically positioned at the narrowed area of the artery. When the catheter's balloon is inflated, the stent expands and is pressed against the vessel wall. The balloon is deflated and withdrawn, leaving the stent permanently in place. After a stent is placed, you will be prescribed an antiplatelet medication, Clopidogrel, also known as Plavix, for one month. This is used to minimize the risk of clot formation in the stent while tissue grows around the stent to incorporate it into the blood vessel wall. Within a month, the body no longer "sees" the stent, and the medication is no longer needed. You should continue to take aspirin, if it has been prescribed, along with the Clopidogrel.
Rotational atherectomy widens narrowed arteries using a high-speed rotational device to "sand" away plaque. This technique is used in particular situations, such as with plaque with large amounts of calcium or to widen blockages within a stent.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
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