Coronary artery disease (CAD) can be managed by a combination of changes in lifestyle and medical treatment.
Changes in lifestyle include:
- Eating a healthy, low-saturated fat diet
- Regular exercise
- Quitting smoking
Medical treatment may include:
- Medications
- Angioplasty with or without stent placement
- Coronary artery bypass graft surgery (CABG, or open heart surgery)
Angioplasty
Angioplasty is a procedure used to open blocked arteries. It’s performed under local anesthesia in a cardiac catheterization laboratory. Here’s how it works:
Step 1
The doctor guides a catheter with a small balloon through the blood vessel to the narrowed section of the artery. By using a fluoroscope (an X-ray device that can be viewed on a TV monitor), the doctor is able to maneuver it into the blocked coronary artery.
Step 2
The balloon is inflated. It pushes out against the wall of the artery, compressing the plaque. The balloon is deflated and the catheter is removed.
Step 3
The inside of the blood vessel is now larger and the blood flow is improved.
The doctor can insert the balloon alone into the artery or also with a permanent device called a stent.
Coronary artery stents
Coronary artery stents are small metallic mesh tubes. They are put over a balloon catheter and placed in the narrowed portion of the coronary artery. Here’s how it works:
Step 1
The doctor maneuvers the catheter into the blocked artery and inflates the balloon.
Step 2
The stent expands against the vessel wall as the balloon is inflated.
Step 3
Once the balloon has been deflated and the catheter is withdrawn, the stent stays in place permanently, holding the blood vessel open and improving blood flow.
Restenosis
Unfortunately, arteries often narrow within 6 months of balloon angioplasty. This is called restenosis and it happens in 30% to 50% of patients. This narrowing can be caused by many factors, including vessel shrinkage and tissue in-growth in the treated area.
Coronary artery angioplasty with stent placement has been proven to reduce restenosis compared with balloon angioplasty alone. Still, within 6 months of coronary angioplasty and stent placement, narrowing recurs in about one third of patients.
Drug eluting stents
A drug eluting stent is a coronary artery stent that has been coated with a drug that is delivered locally to the diseased area. The drug is intended to reduce tissue in-growth, thereby decreasing the need for a follow-up procedure.
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