Besides coronary bypass surgery, what other treatment options are available to a patient with narrowed or blocked arteries?
A severely narrowed coronary artery may need treatment to reduce the risk of a heart attack. Coronary bypass surgery is one form of treatment, but there are other therapies that have been found effective among carefully selected patients.
Angioplasty, which opens narrowed arteries, is performed by interventional cardiologists. They use a small balloon-tipped catheter that they inflate at the blockage site to flatten the plaque against the artery wall. A thin wire is inserted into an artery in the leg and is guided to the site of narrowing in the coronary artery. The catheter is slipped over this guidewire and positioned at the blockage, where the balloon is inflated. After treatment, the wire, catheter, and balloon are removed. The hospital stay and recovery time for this procedure are shorter than that of bypass. But, about 35% of patients are at risk for more blockages in the treated area (called restenosis). If restenosis is going to occur, it will usually happen within 6 months of the procedure.
A stent procedure is used in conjunction with balloon angioplasty. It involves implanting a mesh-like metal device into an artery at a site narrowed by plaque. The stent is mounted on a balloon-tipped catheter, threaded through an artery, and positioned at the blockage. The balloon is then inflated, opening the stent. Then, the catheter and deflated balloon are removed. The opened stent keeps the vessel open and stops the artery from collapsing. Restenosis rates are generally around 15-20%.
Atherectomy may be an option for certain patients who cannot have balloon angioplasty. A high-speed drill on the tip of a catheter is used to shave plaque from artery walls.
Laser ablation uses a catheter that has a metal or fiberoptic probe on the tip. The laser uses light to "burn" away plaque and open the vessel enough so that a balloon can further widen the opening.
Percutaneous transmyocardial revascularization (PTMR) is performed by a cardiologist in the cardiac catheterization laboratory. Using local anesthesia, the cardiologist inserts a long, thin tube (called a catheter) in an artery in the leg that leads to the heart. A laser is then fed through the catheter and used to create tiny holes in the heart muscle. These holes become channels for blood to flow to oxygen-starved areas of the heart. Researchers believe that the procedure may cause new vessels to form, reducing the pain of angina. PTMR is currently being used on patients who have not responded to other treatments such as medicines, angioplasty, or coronary artery bypass surgery.