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Coronary Heart Disease Surgeries and Procedures


Angioplasty

In angioplasty, also called percutaneous coronary intervention (PCI), a catheter with a balloon attached is guided through the coronary arteries. When the catheter reaches the site of obstruction where the arteries are narrowed, the balloon is inflated, flattening the plaque against the artery walls and easing the flow of blood.

This procedure is often effective at relieving symptoms, such as angina, that drug therapy alone could not relieve. It is also the preferred alternative when symptoms are not severe enough to warrant the more invasive coronary artery bypass surgery.

In the past, angioplasty failed to keep blood vessels open in approximately 30 percent of cases, requiring a second procedure, called restenosis. Today, however, the success rate is much higher.

This is in part a result of the use of stents. These devices are essentially metal scaffolds that are inserted into the site where the angioplasty was performed. Now, more than 800,000 PCI procedures are performed each year, exceeding the number of coronary artery bypass surgeries.

Most recently, drug-coated stents have been developed. These are designed to deliver medication directly to the narrowed site. The two most frequently used types of drug-coated stents are the Cypher stent, which is coated with the drug sirolimus, and the Taxus stent, which is coated with the drug paclitaxel. In both these stents, most of the drug is released in the first month.

Although drug-coated stents have reduced restenosis after angioplasty, they have been associated with increased blood clots or heart attack when antiplatelet medications, such as aspirin and clopidogrel, are stopped within the first 12 to 18 months after placement.

All elective surgeries should be postponed until at least 6 to 12 months after a drug-coated stent is placed. For unanticipated dental work or surgery, talk with your doctor before stopping antiplatelet medications. Most dental work can be performed while taking aspirin and clopidogrel, but your dentist must pay close attention to any bleeding.

Many surgeries can also be performed while taking aspirin and clopidogrel, but bleeding is usually increased. If emergency surgery necessitates stopping aspirin and clopidogrel, your cardiologist should be notified in order to monitor your condition. For those who have bare metal stents, clopidogrel is often stopped after four weeks and aspirin continued.

Regardless of the success of an angioplasty procedure and the placement of a stent, it is not a substitute for a lifetime plan for controlling blood cholesterol through diet and drug therapy.

In some cases, a patient might benefit more from a coronary bypass surgery than from angioplasty. Find out what happens in this surgery, and when it is recommended, on the next page.