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Five Nonsurgical Interventional Procedures for Treating Coronary Blockages

If you have been diagnosed with a blocked coronary artery, you should know that nonsurgical interventions are available. These include balloon angioplasty, two different kinds of stents, rotablation, and cutting balloon. Which one your healthcare provider recommends will depend on your individual situation. Keep in mind that this doesn't mean surgery will never be necessary. Long-term results are a factor.

 

Are There Nonsurgical Options for Coronary Blockages?

If your doctor has informed you that you have a blocked artery, your first thought may be that of an emergency bypass surgery. But try not to jump to conclusions just yet. There may be other options -- including some that don't even involve surgery. How is this possible? We are going to take you through five nonsurgical interventional procedures for treating coronary blockages that very well may keep you off the operating table.
 
An "interventional" procedure is a nonsurgical treatment that is used to open coronary arteries that are narrow or blocked. By opening up these arteries, it helps improve blood flow to the heart. These interventional procedures can be done during a cardiac catheterization as soon as a blockage is identified, or they can be done at a later date if needed (see Cardiac Catheterization).
 
These five nonsurgical interventional options your doctor may recommend include:
 
  • Balloon angioplasty
  • Balloon angioplasty with stenting
  • Drug-eluting stent (DES)
  • Rotablation (percutaneous transluminal rotational atherectomy, or PTRA)
  • Cutting balloon.
 
Interventional procedures are done during a cardiac catheterization, which is why they're also known as percutaneous coronary interventions (PCAs). After the catheter is in place, one of the interventional procedures is done to open up the artery.
 
You may or may not have heard of these, so let's take a closer look at what's involved with each of them. Knowing what's involved with these procedures will help you know what to ask your doctor when trying to decide which treatment is best for you.
 
Balloon Angioplasty
Balloon angioplasty, also called percutaneous transluminal coronary angioplasty (PTCA), is performed to open blocked coronary arteries and improve blood flow to the heart without having to do open-heart surgery
 
This procedure involves using a small balloon that is located at the tip of the catheter (a long, hollow tube). It is inserted through a blood vessel in the groin and threaded up to the heart, near the blocked or narrowed part of the coronary artery. Once in the right spot, the balloon is inflated and the blockage is compressed against the artery walls to make a larger opening inside the artery for improved blood flow.
 
A special type of x-ray called fluoroscopy is used to help the doctor see the location of the blockages as a contrast dye moves through the arteries.
 
Balloon Angioplasty With Stenting
Coronary stents are almost universally used in PCI procedures. A stent is a small, expandable, metal mesh tube that is inserted inside the artery to give it support to stay open.  
 
After the proper placement is determined, the balloon is inflated and the stent is expanded to the size of the artery. It acts as a sort of scaffold to help hold the artery open. The balloon is then deflated and removed, while the stent remains in place.
 
After the stent is placed permanently inside the artery, it can be expanded and stretched to fit the size, shape, and bend of the artery. For the old-style bare-metal stents, within a few days after the procedure, tissue will begin to form over the stent. It will usually take about a month for the stent to get completely covered by the natural tissue. For the newer, drug-eluting types of stents (see the next section for more information), it can take considerably longer for the stent to heal over.
 
This particular procedure is the most commonly recommended treatment for those who have a blockage in one or two coronary arteries. However, if more than two coronary arteries are blocked, then a bypass surgery may be the best option.
 
Drug-Eluting Stents
As the name implies, these stents contain a medicine that is released at the site where the stent is placed. These particular stents have a thin surface of medication that helps to reduce the risk of restenosis, which is when a blood vessel narrows after it has been opened. This medication helps to prevent the overgrowth of tissue that can occur within the stent.
 
If your doctor recommends this particular stent, you will likely receive certain prescription medications that you will have to take for several months after your procedure to prevent the risk of clotting. Some concerns were raised in 2006 regarding the risk of blood clots forming with these stents, which can lead to a heart attack. However, the U.S. Food and Drug Administration (FDA) has stated that DES are safe and effective when used appropriately. If you have a DES, make sure to take your medications as prescribed until your doctor tells you to stop.
 
Rotablation (PTRA)
This procedure uses a catheter that has an acorn-shaped, diamond-coated tip. It is inserted up to the place where the blockage is located, and then the tip spins around at a high speed, grinding away at the plaque on the walls of the artery (think of something similar to a dentist's drill). This process can be repeated as necessary to remove blockage and improve blood flow.
 
But what happens to all those chopped-up pieces of cholesterol and fatty deposits (plaque) inside the artery? The rotablation causes these to become microscopic particles that are washed away in the bloodstream and filtered out by the liver and spleen.
 
Cutting Balloon
As you might expect with this procedure, a cutting balloon includes a balloon tip that has small blades. Once the balloon is inserted into the right place in the artery, the blades are activated. They score the plaque, and then the balloon pushes the fatty deposits into the walls of the artery. A doctor may recommend this type of procedure if a person has already had a stent put in place, but the arteries have become narrow again (restenosis) or if they have other types of blockages.
 
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