Advances in Treatment for Coronary Artery Disease
Coronary artery disease, CAD, occurs when the arteries that carry blood to your heart become thickened or blocked altogether, most often with a substance called plaque. This slows down or completely stops oxygen-rich blood from reaching your heart, possibly causing angina (chest pain) or a heart attack. CAD is the most common type of coronary disease in the United States.
Research has come a long way over the years when it comes to treating CAD and cardiologists now have options to offer their patients, ranging from medications to surgery. How your cardiologist chooses to treat your individual case will depend on how badly your coronary arteries are blocked, your overall health, and your prognosis or outcome.
If the narrowing in your coronary artery is not preventing adequate blood flow to your heart, your doctor may choose to prescribe cholesterol-modifying medications to try to prevent further plaque build-up. These medications may include:
Fibrates, such as fenofibrate (Antara) and fenofibric acid (Trilipix®)
Bile acid sequestrants, such as cholestyramine (Questran) and colestipol (Colestid)
Other medications help relieve some of the signs and symptoms of CAD, such as aspirin to thin your blood, or beta blockers, such as metoprolol (Lopressor) and nadolol (Corgard), to help lower your blood pressure.
An angioplasty is a minimally invasive procedure, which means there are no large incisions. Minimally invasive procedures are done as often as possible now because they tend to have fewer complications and the recovery time is generally shorter than it would be for open surgery.
To do an angioplasty, a doctor inserts a thin, flexible catheter into an artery (usually in your groin) and threads it up to the coronary artery. Using X-ray to visualize the inside of your artery, the tip of the catheter is brought to the narrowed or blocked area. A balloon is inflated inside the artery, pushing the walls open. Once the artery is reopened, there is a chance it could narrow again, so your doctor may choose to insert a stent. A stent is a narrow metal mesh tube that acts as a support inside the artery. Tissue in the arterial wall starts to grow around the stent and holds it in place.
Plain stents hold your artery walls open, but the overgrowth of tissue and scarring can increase your risk of developing blood clots in the area, or the scar tissue can cause narrowing of the area again. To avoid this, many doctors insert drug-eluting stents. These are stents that have been coated with a time-release medication that is released slowly and prevents tissue build-up and scarring.
Stents to keep open coronary arteries have been saving lives for millions of people, but researchers continue to improve upon current technology. One current concern is permanent stents may eventually damage the blood vessel wall because the wall is flexible but the stent is not. One response has been to develop a dissolvable stent, one which will disappear over time after it has stabilized the arterial wall. Clinical trials of these dissolving drug-eluting stents found they were just as effective as the permanent types.
These newer stents have similar risks associated with them as with the permanent ones, but there are some additional drawbacks that have yet to be resolved. The dissolving stents are more difficult to insert, require more X-ray tests during insertion, and don’t seem to be as effective in smaller blood vessels. That being said, some doctors believe the advantages outweigh the potential problems, and further research is being done to see how they can fine-tune the devices.
If angioplasty is not an option to treat your CAD, your doctor may recommend you have open heart surgery called coronary bypass surgery. Coronary bypass surgery allows your surgeon to create a graft, another route for the blood to reach your heart, which bypasses the blocked artery. This is done most often when there is more than one blood vessel that is blocked.
Regardless of the type of treatment you have for your CAD, it’s important to maintain heart-healthy habits to reduce the risk of repeat problems. Speak with your doctor about how best to adapt your lifestyle.