Coronary Revascularization

Coronary revascularization is the procedure used to treat coronary artery disease when the coronary arteries become severely blocked. Coronary artery disease is a result of atherosclerosis, a disease that narrows large arteries and limits blood supply to vital organs. Coronary artery disease may reduce blood supply to the heart muscle and can lead to chest pain, heart attack, and possibly sudden death.

Coronary artery disease can be stabilized and treated through the use of medication and healthy living; however, when the arteries are severely blocked, a revascularization procedure is required. The two procedures to manage a blocked coronary artery are to implant a stent in the area of blockage (angioplasty) or to entirely bypass the blocked segment of artery surgically (bypass surgery).

Choosing Between Angioplasty and Bypass Surgery

The heart has three major coronary arteries, each supplying a different area of the heart muscle. When a single artery is blocked, angioplasty is often preferred over surgery, because it is less invasive and recovery is much faster. When multiple arteries are blocked, a decision must be made between angioplasty to the multiple blockages or bypass surgery. In some cases, arteries are blocked in a way that only one revascularization choice is possible.

A patient will receive coronary revascularization if he or she has coronary artery disease. If your coronary arteries are narrow, they can’t supply enough oxygen-rich blood to your heart, especially during activities where it may be beating harder than usual such as exercise. At first, the decreased blood flow may not cause any symptoms. As plaque continues to build, you may develop the following symptoms:

• Chest Pain. You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain is referred to as angina
• Shortness of Breath. If your heart can’t pump enough blood to meet your body’s needs, you may develop shortness of breath or extreme fatigue with exertion
• Heart Attack. A completely blocked coronary artery will cause a heart attack. Signs of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating.

Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes or insulin resistance
• Sedentary lifestyle

Risks factors of coronary artery disease include:

• Age
• Sex
• Family history
• Smoking
• High blood pressure
• High blood cholesterol levels
• Diabetes
• Overweight or obesity
• Physical inactivity
• High stress
• Unhealthy diet

The two procedures to manage a blocked coronary artery are to implant a stent in the area of blockage (angioplasty) or to entirely bypass the blocked segment of artery surgically (bypass surgery).

PERCUTANEOUS CORONARY INTERVENTION (ANGIOPLASTY)

Percutaneous coronary intervention (PCI; angioplasty) is a minimally invasive procedure in which a tube with an associated balloon is introduced via a peripheral artery. The procedure is meant to widen narrowed or obstructed arteries or veins.

Angioplasty will be performed in a hospital. The doctor threads a tube through a blood vessel in the arm or groin and up into the involved site in the artery. The tube has a tiny balloon on the end that will inflate to push the plaque outward against the wall of the artery, widening the artery and restoring blood flow. This can reduce chest pain and minimize the chance of a heart attack.