Coronary disease, in other words the stenosis (the narrowing or blockage) created in the heart’s arteries (which are called coronary arteries), is the most common heart disease in the Western world and in Greece. The main factors contributing to the huge increase in coronary disease cases in our days are, in order of priority, smoking, high cholesterol levels, high blood pressure and high blood sugar levels.
The heart is a muscle. To function, it needs blood, which reaches it through the coronary arteries. Coronary disease is caused by atherosclerosis, which creates blockages inside these arteries. These blockages are caused by the accumulation of what is known as atheromatous plaque. (http://www.webmd.com/heart-disease/video/atherosclerosis) This plaque hinders blood flow and prevents proper blood supply to the heart.
Indirect information on the existence of blockages in the coronary arteries can be obtained from stress tests, ultrasounds and myocardial scintigraphy. However, the ultimate and most precise test yielding the most reliable information on the existence of stenoses is the coronary angiography.
How is coronary disease treated?
Coronary disease can be treated using three different methods or even with a combination of some or all of these methods:
- Angioplasty (balloon and stent usage)
- Open-heart surgery (coronary artery bypass surgery)
Overview. What is angioplasty?
Angioplasty is the method we use to deal with a stenosis in the heart’s arteries. We essentially use a special narrow catheter with a small balloon at its tip which we can inflate at the site of the stenosis. As it inflates, the balloon pushes aside and compresses the atheromatous plaque causing the stenosis on the artery’s wall, and some fragments are washed into the bloodstream. We then use another special catheter that has a metal tube known as a stent on one end and we insert the stent in the narrowed artery. We now inflate the little balloon inside the stent, in this way forcefully expanding it at the desired site. This balloon ‘sticks’ to the artery walls and enables normal blood flow.
We now use the stent in all angioplasty cases, since with angioplasty using only a balloon there is a 20% possibility that another blockage will occur in the artery, while with the new-generation stents there is only a 2 to 5% risk of reblockage.
Patients that have had angioplasty must take special anticoagulant (blood thinning) medication, usually for a year.
Angioplasty for myocardial infarction
The primary goal in the case of a myocardial infarction, commonly known as a heart attack, is to get the patient to the haemodynamic lab as quickly as possible in order to perform angioplasty. There, once a coronary angiography has been performed and the damage has been determined, we can suck out the blood clot that caused the blockage and the heart attack and can then proceed with angioplasty to deal with the narrowed artery. In the last few years our team has been performing what is known as primary angioplasty for heart attacks, which is the immediate treatment of a heart attack using angioplasty. For this purpose, in cooperation with St. Luke’s Hospital, we offer our medical services 7 days a week, 24 hours a day.
Today, both coronary angiography and angioplasty can be performed through the arm, using the radial artery access. This method, which our team has been using successfully over the last three years, has led to a significant reduction in the complications that occur when the procedure is performed via the femoral artery (haematomas, pseudoaneurysms). It has also greatly reduced patient discomfort after the procedure, since patients can now get up immediately.
A special technique that our team uses to deal with very ‘hard’ (calcified) stenoses which cannot be corrected in the normal manner using a balloon, is rotablation.
This technique makes use of a rotablator, which is essentially a microscopic drill that rotates at a speed of 100.000 to 150.000 revolutions per minute and actually ‘eats away’ at the atheromatous plaque, breaking it up into tiny fragments.
When we are not entirely certain about the extent of the stenosis and consequently whether a procedure is needed, we use a special catheter with a tiny built-in camera that allows us to assess the artery’s diameter and the extent of the stenosis. This method is called intravascular ultrasound (IVUS).
Frequently Asked Questions
Is angioplasty a simple procedure?
Angioplasty requires specialization and experience. Determining whether the procedure is necessary or not, choosing the correct materials, the most suitable method and appropriate medication and properly monitoring the patient after the procedure are all necessary conditions that must be met to ensure excellent results without subsequent problems.
How dangerous is it?
In experienced hands and in the right environment, it is truly a very low-risk procedure. There is a risk in less than 1% of cases.
What are the most common complications?
Complications usually occur at the catheter insertion site, more usually in the leg and less frequently in the arm. Localized blood clotting and limited or more extensive bleeding are the most common and mainly occur in angioplasty through the leg. Very rare complications include minor strokes, arrhythmias or heart attacks.
How long does one usually stay in hospital?
The usual stay is 1 to 2 days. In the first few hours after the procedure, patients are kept in the Coronary Unit, where they can be more closely monitored.
How long will one have to take medication?
Medication is usually taken for at least 12 months.
How soon can one resume one’s normal activities?
Every patient is a different case. We usually recommend a one week recuperation period, but for heart attacks the corresponding period is one month.
Why do some patients have surgery while others get a stent?
It is up to the patient to make the final choice. Our duty is to inform patients and the people supporting them about the pros and cons of each method. Usually, when there are many stenoses in the heart’s arteries or when a particular anatomy makes angioplasty problematic, then surgery may be preferred.
Why choose us?
Our team offers round-the-clock medical assistance every day of the year. It is furthermore made up of highly experienced and highly trained experts from institutions in Greece and in large European and American cities. St. Luke’s excellent working and health care conditions, the Haemodynamic Lab’s and Intensive Care Unit’s modern facilities and the close cooperation between doctors of all specialties ensure the best results for you and your loved ones.