Management of Coronary Artery Disease

You can do a lot to control cardiovascular disease. Take medication. Change your diet. Exercise. When these changes aren't enough, your doctor may recommend a stent implant or bypass surgery.

Your doctor will determine the best option for you based on the underlying problems, where and how severe your blockages are, and your future risks.

Pharmaceutical Therapy

When atherosclerosis is identified at an early stage, medications such as nitrates, beta blockers, calcium channel blockers, aspirin, or cholesterol-lowering drugs (statins) may be prescribed. These medicines may slow the disease's progress or ease its symptoms.

Bypass Surgery

Coronary artery bypass grafting, or "CABG" (pronounced "cabbage"), is a common heart procedure. A surgeon takes a section of a healthy blood vessel from your leg, chest, or arm. The vessel is then connected (grafted) to your coronary artery slightly past the site of the blockage. This creates a new path for blood to flow around (bypass) the blockage in the artery so it can get to your heart.

Patients undergoing bypass are put under general anaesthetic and are not awake during surgery. Two bypass surgical procedures for coronary artery disease are: (1) beating heart surgery and (2) arrested heart surgery.

• Beating heart surgery – Also known as off-pump surgery, beating heart surgery is done while the heart is beating. This often requires special equipment that allows the surgeon to operate on the heart while it is moving. Beating heart surgery is appropriate for certain patients.

• Arrested heart surgery – Most CABG surgeries are done through an incision in the chest while the heart is stopped and a heart-lung machine takes over the job of circulating the blood. This is called arrested heart surgery or conventional bypass surgery.

Minimally Invasive Options 

For some patients, minimally invasive coronary artery surgery is an alternative to the CABG surgery. Three minimally invasive options for coronary artery disease (CAD) are coronary balloon angioplasty, stenting, and minimally invasive cardiac surgery (MICS) CABG.

• Coronary balloon angioplasty – Coronary balloon angioplasty, also referred to as percutaneous (through the skin) coronary intervention (PCI), uses a tiny balloon to widen the inside channel of the artery and enable blood to flow at a normal or near-normal rate.
• Stenting – Stenting uses a device called a stent to restore blood flow in the coronary artery. A stent is a tiny, expandable, mesh-like tube made of a metal such as stainless steel or cobalt alloy. Like in an angioplasty procedure, a stent mounted onto a tiny balloon is opened inside of an artery to push back plaque and to restore blood flow.
• MICS CABG – The beating heart procedure described above can be performed through a small rib incision rather than through a median sternotomy.

In some cases, stents and balloons are used together in a procedure called stent and balloon therapy.

Next: About  Minimally Invasive Procedures and Surgery